Early Palliative Care for Patients with Metastatic Non-Small-Cell Lung Cancer

Massachusetts General Hospital, Boston, MA 02114, USA.
New England Journal of Medicine (Impact Factor: 55.87). 08/2010; 363(8):733-42. DOI: 10.1056/NEJMoa1000678
Source: PubMed


Patients with metastatic non-small-cell lung cancer have a substantial symptom burden and may receive aggressive care at the end of life. We examined the effect of introducing palliative care early after diagnosis on patient-reported outcomes and end-of-life care among ambulatory patients with newly diagnosed disease.
We randomly assigned patients with newly diagnosed metastatic non-small-cell lung cancer to receive either early palliative care integrated with standard oncologic care or standard oncologic care alone. Quality of life and mood were assessed at baseline and at 12 weeks with the use of the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale and the Hospital Anxiety and Depression Scale, respectively. The primary outcome was the change in the quality of life at 12 weeks. Data on end-of-life care were collected from electronic medical records.
Of the 151 patients who underwent randomization, 27 died by 12 weeks and 107 (86% of the remaining patients) completed assessments. Patients assigned to early palliative care had a better quality of life than did patients assigned to standard care (mean score on the FACT-L scale [in which scores range from 0 to 136, with higher scores indicating better quality of life], 98.0 vs. 91.5; P=0.03). In addition, fewer patients in the palliative care group than in the standard care group had depressive symptoms (16% vs. 38%, P=0.01). Despite the fact that fewer patients in the early palliative care group than in the standard care group received aggressive end-of-life care (33% vs. 54%, P=0.05), median survival was longer among patients receiving early palliative care (11.6 months vs. 8.9 months, P=0.02).
Among patients with metastatic non-small-cell lung cancer, early palliative care led to significant improvements in both quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival. (Funded by an American Society of Clinical Oncology Career Development Award and philanthropic gifts; ClinicalTrials.gov number, NCT01038271.)

Download full-text


Available from: Vicki A Jackson,
    • "Advances in the management of late-stage cancer are accompanied by a host of challenges for individuals, families, and society (Aronowitz, 2010). In particular , the use of aggressive cancer-directed therapies in persons with very advanced disease is associated with psychosocial, physical, and existential distress and poorer quality-of-life (Schroepfer, 2007; Temel et al., 2010; Tullis, 2010; Wright et al., 2008). Geriatric cancer patients are particularly susceptible to the toxic side-effects of chemotherapy (Balducci, 2006). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Disease-directed therapy near death is a growing trend among persons living with late-stage cancer. As a sociocultural phenomenon, cancer-directed therapy (e.g., chemotherapy) when given for very advanced disease is a process that offers questionable benefits and portends further suffering, but also suggests potential for growth and transcendence. Theories and concepts drawn from cultural anthropology, sociology, and existentialism illustrate how contextual factors contribute to the creation of a “liminal space”; the latter part of the cancer trajectory where living and dying can overlap. When applied to clinical practice, this theoretical framework gives the patient, family, and health care provider a way of “unmasking” a period of transition during terminal illness when aggressive disease-directed care continues to be provided. The liminal space may function as an existential plane; a gateway or threshold with inherent potential for psychospiritual development during the final stage of life.
    OMEGA--Journal of Death and Dying 06/2015; 71(2):99-125. DOI:10.1177/0030222815570589 · 0.44 Impact Factor
  • Source
    • "Evidence of intensive chemotherapy use near the end-of-life is not, in itself, evidence of harm. However, a number of these studies have also demonstrated that compared to patients not receiving drug treatment close to death, such treatment is associated with poorer quality of life and death e for example, a higher number of emergency room visits and admissions to ICU, fewer hospice services , decreased likelihood of patients dying in their preferred place, increased physical and psychological distress and, in some countries, bankruptcy (Earle et al., 2004; Greer et al., 2011; Mack et al., 2010; Temel et al., 2010; Wright et al., 2014; Zafar et al., 2013). Moreover, patients receiving chemotherapy near the endof-life do not live longer than patients not receiving such therapy (Nappa et al., 2011; Saito et al., 2011; von Gruenigen et al., 2008). "
    [Show abstract] [Hide abstract]
    ABSTRACT: There is evidence from some countries of a trend towards increasingly aggressive pharmacological treatment of patients with advanced, incurable cancer. To what extent should this be understood as a progressive development in which technological innovations address previously unmet needs, or is a significant amount of this expansion explained by futile or even harmful treatment? In this article it is argued that while some of this growth may be consistent with a progressive account of medicines consumption, part of the expansion is constituted by the inappropriate and overly aggressive use of drugs. Such use is often explained in terms of individual patient consumerism and/or factors to do with physician behaviour. Whilst acknowledging the role of physicians and patients’ expectations, this paper, drawing on empirical research conducted in the US, the EU and the UK, examines the extent to which upstream factors shape expectations and drive pharmaceuticalisation, and explores the value of this concept as an analytical tool.KeywordsUnited StatesUnited Kingdompharmaceuticalizationend-of-life cancer careexpectationsovertreatmentpatient preferencesclinical benefit
    Social Science & Medicine 12/2014; 131. DOI:10.1016/j.socscimed.2014.12.007 · 2.89 Impact Factor
  • Source
    • "Such variations can impact substantially on both access to clinical trials and outcome; standardization of patient management across Europe could well improve the outlook for individuals with PDAC. A further factor that may improve outcomes for patients with PDAC is the introduction of palliative care soon after diagnosis, since this approach had been shown to result in improvement in both quality of life and survival in patients with non-small cell lung cancer [138] [139]. Additional approaches aimed at improving outcomes in PDAC are listed in Table 4. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Pancreatic ductal adenocarcinoma (PDAC), which accounts for more than 90% of all pancreatic tumours, is a devastating malignancy with an extremely poor prognosis, as shown by a 1-year survival rate of around 18% for all stages of the disease. The low survival rates associated with PDAC primarily reflect the fact that tumours progress rapidly with few specific symptoms and are thus at an advanced stage at diagnosis in most patients. As a result, there is an urgent need to develop accurate markers of pre-invasive pancreatic neoplasms in order to facilitate prediction of cancer risk and to help diagnose the disease at an earlier stage. However, screening for early diagnosis of prostate cancer remains challenging and identifying a highly accurate, low-cost screening test for early PDAC for use in clinical practice remains an important unmet need. More effective therapies are also crucial in PDAC, since progress in identifying novel therapies has been hampered by the genetic complexity of the disease and treatment remains a major challenge. Presently, the greatest step towards improved treatment efficacy has been made in the field of palliative chemotherapy by introducing FOLFIRINOX (folinic acid, 5-fluorouracil, irinotecan and oxaliplatin) and gemcitabine/nab-paclitaxel. Strategies designed to raise the profile of PDAC in research and clinical practice are a further requirement in order to ensure the best treatment for patients. This article proposes a number of approaches that may help to accelerate progress in treating patients with PDAC, which, in turn, may be expected to improve the quality of life and survival for those suffering from this devastating disease.
    Pancreatology 10/2014; 15(1). DOI:10.1016/j.pan.2014.10.001 · 2.84 Impact Factor
Show more