Starting palliative care early does not only lengthen survival time but it can enhance quality of life and ward off depression, according to a new study appearing in the New England Journal of Medicine. The study assessed the effects of palliative care on patient with advanced lung cancer, the deadliest form of cancer worldwide.

Because previous studies have shown that late use of palliative care does not enhance the quality of care nor lengthen lives, researchers set out to measure the impact of early adoption. Looking at patients with metastatic non-small-cell lung cancer, they compared two courses of treatment. One group of 74 patients received normal medical care while a second group of 77 patients received standard care supplemented with palliative care services immediately after diagnosis.

The latter group met with the palliative care team within three weeks of the onset of the study—soon after their respective diagnoses—and then monthly throughout the duration of their illness. The palliative care team, consisting of physicians, nurses, social workers and chaplains, addressed an array of areas—assessing and treating symptoms, establishing goals of care, providing psychosocial support and coordinating care with other services.

"One of the most common misconceptions about palliative care is that it indicates treatment has failed—that it means giving up," says study co-author Vicki Jackson, MD, MPH. "In this study the addition of palliative care early in the course of illness extended the survival of patients with incurable lung cancer. These patients not only lived longer, they also experienced improved quality of life and were better able to enjoy the time they had remaining."

Patients who received palliative care services lived an average of 11.6 months after diagnosis, a two-and-a-half month increase over the average of patients receiving standard care, which was nine months. In addition to extended survival, patients receiving palliative care services had a lower depression rate by half and they were more likely (50 vs. 30 percent) to have created clear end-of-life resuscitation preferences.

"Traditionally, cancer care has focused on treating the disease itself, but now we realize we must also focus on managing patient's symptoms and distress related to their diagnosis,” says Dr. Jennifer Temel, the paper’s lead author. “We hypothesize that the increased survival was due to improved mood and quality of life, to early and more comprehensive management of symptoms and complications, and possibly to more appropriate end-of-life care. Similar studies in patients with other types of cancers and in other care settings will help us better understand the impact palliative care can have on the well-being and health of all patients with cancer."

The study was released August 19 in the New England Journal of Medicine. Research took place at Massachusetts General Hospital in Boston.
 

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