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Early palliative care may improve quality of life for family caregivers
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The introduction of palliative care early after a diagnosis of incurable cancer improved the quality of life of the patients’ family caregivers, according to the results of a randomized trial scheduled for presentation at the ASCO Annual Meeting.
“We are seeing an impact of early palliative care for patients with early diagnosed disease and their families,” Areej R. El-Jawahri, MD, director of the bone marrow transplant survivorship program at Massachusetts General Hospital Cancer Center, said during a press briefing. “It seems like the improvement experienced by family caregivers appeared to be at least partially mediated by an improvement in patient quality of life.”
Areej R. El-Jawahri
Early palliative care increases quality of life for patients with cancer, and recent studies have shown that a psycho-educational intervention via telephone can decrease depression for patients’ family caregivers. However, the effects of early, integrated outpatient palliative care models on family caregiver outcomes had been unknown.
Between May 2011 and July 2015, El-Jawahri and colleagues enrolled 350 patients newly diagnosed with incurable lung or gastrointestinal cancer, 78.6% of whom (n = 275) had an eligible family caregiver, defined by the patient as a family member or friend who would assist with care.
Researchers randomly assigned patients and their participating family caregivers to receive oncology care alone (n = 138) or with early palliative care (n = 137).
The palliative care intervention required at least one monthly visit from the time of enrollment. Although family caregivers were not required to be present, approximately 50% were present during palliative care visits.
These visits focused on symptom management, coping, establishing rapport and illness education. Prevalent symptoms addressed in the visits included pain (58.4%), fatigue (52.1%), nausea (21.7%) and anxiety (18.1%). The most common coping topics included redirecting hope (71.1%), coping counselling (70.2%) and behavioral coping (65.4%).
Researchers assessed caregivers’ quality of life using the Medical Outcomes Study Health Survey Short Form-36 (SF-36) and mood using the Hospital Anxiety and Depression Scale at baseline, week 12 and week 24. Rates for missing outcome data were 16.8% at 12 weeks and 33.8% at 24 weeks.
At 12 weeks, participating family caregivers who cared for a patient in the palliative care group experienced higher vitality (1.1 vs. –3.2, P = 0.05) and higher social functioning (–3.0 vs. –3.8, P = 0.02) than family caregivers of patients who did not receive early palliative care.
Further, family caregivers in the palliative care group experienced fewer depression symptoms (–0.45 vs. 0.24, P = 0.03).
At 24 weeks, the data showed no differences in vitality or social functioning between the two groups. However, family caregivers of the palliative care patient group reported fewer depression symptoms (–0.37 vs. 0.28, P = 0.05).
Researchers reported no significant differences in other SF-36 subscales of anxiety during both follow-up points.
“This study suggests that early palliative care creates a powerful feedback loop in families facing cancer," El-Jawahri said in a press release. “While patients receive a direct benefit from early palliative care, their caregivers experience a positive downstream effect, which may make it easier for them to care for their loved ones.” – by Nick Andrews
Reference:
El-Jawahri A, et al. Abstract 10131. Presented at: ASCO Annual Meeting; June 3-6, 2016; Chicago.
Disclos ure: El-Jawahri reports no relevant financial disclosures. Other researchers report consulting/advisory roles with Amorsa Therapeutics and MPM Capital; patents, royalties, or other intellectual property with McGraw Hill Chapter Royalties and Johns Hopkins University Press; stock and ownership interest in McGraw Hill Chapter royalties; and honoraria, travel expenses and research funding from MPM Capital, UpToDate and Helsinn Therapeutics.
Perspective
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Holly G. Prigerson, PhD
It is important to demonstrate how the care patients with cancer receive affects the bereavement adjustment of surviving family members. Several studies have demonstrated this, but this study by El-Jawahri and colleagues is among the few looking at outcomes of a palliative care intervention. Although these results probably will not lead to earlier implementation of palliative care services, they provide another benefit supporting early integration. If there had been concerns about family outcomes, then this would put those concerns to rest. But, it is doubtful this is going to factor prominently in the timing of palliative care.Perspective
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Julie M. Vose, MD, MBA, FASCO
The study points out that we have so many ways to help patients and their families throughout treatment. Early palliative care is going to help not only the patient, but also family members and caregivers. Early palliative care will go beyond assisting the patient throughout treatment to improve their quality of life and the quality of life of the caregivers.
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