House Call: Benefits of palliative care with cancer patients

Dr. Seth Sullivan from Baylor Scott and White joined us another House Call.

Today on First News at Four he talked about the benefits of palliative care with cancer patients.

More information from a recent article featured in Medscape:
Evidence has shown that palliative care relieves symptoms and improves quality of life (QOL) in patients with serious or life-threatening illnesses. But now a new study demonstrates that early palliative care can improve coping strategies, which appear to be associated with the downstream effects of enhancing QOL and reducing depressive symptoms.

"We now know that early integrative palliative care may improve these outcomes by providing patients with the skills to cope effectively with life-threatening illness," said lead author, Jamie M. Jacobs, PhD, a clinical psychologist at Massachusetts General Hospital Cancer Center in Boston. "Patients who had improvements in active coping correspondingly did have improvements in quality of life, and this was an indirect effect that was significant."
Other factors, she noted, such as symptom management, spiritual support, and self-efficacy, may have also improved outcomes.
Dr Jacobs presented the findings here at the Palliative Care in Oncology Symposium (PCOS) 2017.

Patients with advanced cancer may experience poor QOL, depression, and anxiety, and Dr Jacobs noted that a recent trial conducted by her group showed that early integrative palliative care improved QOL and reduced depressive symptoms in patients with newly diagnosed incurable lung and gastrointestinal (GI) cancers.
But the key mechanisms by which this palliative care model led to improvements in patient outcomes are unclear.

"What we don't know is how it happened," said Dr Jacobs. "How does palliative care confer its benefit? This is less clear and what we wanted to investigate."

Palliative care visits, as reported by clinicians, involve monitoring and managing symptoms, helping patients cope, building rapport, and helping patients understand and make important treatment decisions.

Dr. Jacobs and her colleagues decided that they wanted to look more at coping and figure out whether patients who participate in early integrative palliative care have an improvement or reduction in certain coping mechanisms.
They also decided to take it a step further and see whether the degree to which changes in coping mediated intervention effects on QOL and depressive symptoms.
Active Coping Improved Outcomes

A total of 350 patients with newly diagnosed incurable lung or noncolorectal GI cancer were enrolled in a randomized trial of early palliative care integrated with oncology care vs oncology care alone at Massachusetts General Hospital.
All patients completed self-report measures of QOL (Functional Assessment of Cancer Therapy-General), depressive symptoms (Patient Health Questionnaire-9), and use of active and avoidant coping strategies (Brief COPE, a validated measure of coping strategies) at baseline, 12 weeks, and 24 weeks.