January 28, 2013 | by Shawn Le
Palliative care is often misunderstood by patients – and by physicians. Much too often, it is thought of as end-of-life care, offered in hospices when treatment efforts have been abandoned. In fact, palliative medicine is about helping patients better manage their treatment experience, specifically pain and side effects.
The misconception means that too many patients don’t get the care they need. A new study published online today in the journal JAMA Internal Medicine reinforces the benefits of making palliative care an integral part of lung cancer treatment.
Previous studies had established that palliative care does improve patients' experiences and treatment outcomes. Researchers for the new study wanted to identify what was happening during early palliative care clinics, understand when key issues were addressed during the course of treatment, and compare how physicians and palliative specialists each reacted during these critical time points.
Understanding the key issues discussed, and when they're discussed, can enable medical experts to create effective guidelines for integrated palliative care in the treatment of cancers and other diseases.
Researchers at Massachusetts General Hospital in Boston and at Fred Hutchinson Cancer Research Center in Seattle examined the medical data of 20 randomly-selected lung cancer patients who had received palliative care as part of their treatment. They each analyzed the histories of five patients who survived less than three months, up to six months, up to one year and up to two years.
The researchers found not only that patients who saw both their primary oncologist and a palliative care specialist were able to discuss their symptoms and illness status, but that their palliative visits also led to discussion of psychosocial elements, such as coping.
Karen Reckamp, M.D., M.S., a lung cancer specialist at City of Hope who was not involved in the study, sees a lung cancer diagnosis as “affecting all aspects of a patient’s life, including physical, psychosocial, social and spiritual issues.” In her experience, family members and friends also feel the impact of diagnosis. Any successful treatment has to extend beyond just killing the tumor.
“This research underscores the importance of involving integrated teams of specialists in a person's care to address the multitude of needs one experiences with lung cancer,” said Reckamp. “Implementing early palliative care discussions and interventions with cancer therapy benefits symptoms and has the potential to prolong life.”
Reckamp says caring for the whole patient makes a difference in the treatment experience.
“The complex issues associated with a lung cancer diagnosis can be better addressed using both standard oncology care and early palliative care interventions,” she said. “Early results have shown that adding early palliative care to standard therapies for lung cancer can improve symptoms and prolong life. This may even lower health-care costs as patients develop a deeper understanding of their needs and desires during the course of the disease, which can decrease aggressive interventions that do not improve outcomes.”
Despite the benefits of integrating palliative care into standard cancer treatments, the stigma palliative care still holds for many patients can be an obstacle to even talking about it. Reckamp has found herself in that difficult position before, and expects similar situations in the future as long as “palliative care gets misinterpreted to mean end-of-life care,” especially with cancers that have low survival rates.
“It is a difficult balance, which requires time, compassion and multiple skilled members of the health-care team to implement,” said Reckamp. “In oncology, we must hold conflicting and competing aspects of a lung cancer diagnosis in balance, meaning that hope and therapy to improve the disease can be achieved at the same time as holding conversations about how to handle the knowledge that one has a terminal diagnosis.”
The study researchers noted in their paper: “Further research is needed not only to determine the generalizability of the benefits of early integrated [palliative care] but also to identify the components of the intervention that might be most effective."
Reckamp says that “all interventions that lead to improvement in symptoms and suffering can be referred to as palliative care.” Opening the discussion of palliative care options is the first step that both patients and physicians need to be willing to take.