Cancer patients who start palliative care early avail significant improvements in various parameters, research suggests.
A new randomized clinical trial led by Dartmouth researchers Kathleen Lyons, ScD, Tor Tosteson, ScD, Zhigang Li, PhD, and colleagues found that individuals who began palliative care early experienced significant improvements in multiple metrics. “Early Versus Delayed Initiation of Concurrent Palliative Care Oncology: Patient Outcomes in the ENABLE III Randomised Controlled Trial,” published recently in the Journal of Clinical Oncology, describes their findings.
“Early interventions for caregivers lowered their depression and stress burden in the last month of the patient’s life,” the authors state.
What is palliative care?
Palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure. Patients in palliative care may receive medical care for their symptoms, or palliative care, along with treatment intended to cure their serious illness. Palliative care is meant to enhance a person’s current care by focusing on the quality of life for them and their family.
Earlier intervention strategy improves further survival for cancer patients
“Survivorship and quality of life are of great interest in clinical cancer research but can be difficult to evaluate because of high mortality and the need to measure patient-reported outcomes,” explained Tosteson, a biostatistician at Dartmouth’s Norris Cotton Cancer Centre (NCCC). “We developed trial designs and analytic methods that allow the joint estimation and comparison of survival and quality of life data between different treatment strategies. The ENABLE trials have helped to establish the beneficial effects of palliative care on overall survival by interventions targeting patient outcomes,” he added.
The previous ENABLE II trial by the same team showed that a well-structured intervention for patients with late-stage malignancies enhanced quality of life and survival. According to the recently published ENABLE III study, an earlier intervention technique enhanced survival even more.
Early interventions for caregivers lowered their depression and stress burden in the last month of the patient’s life
In this study, researchers looked at the results of palliative care that began at the first visit or three months later in 207 patients with advanced disease. Although the patient-reported outcomes of early-entry individuals were not statistically different from those of late-entry participants, their one-year survival after enrolment was better compared to those who entered later. Additionally, carer results were enhanced.
“Early interventions for caregivers lowered their depression and stress burden in the last month of the patient’s life,” reported Lyons.
Dartmouth’s Shared Resources system, notably the Biostatistics Shared Resource and the Office of Clinical Research, were critical in carrying out this experiment. Dartmouth’s Geisel School of Medicine’s Division of Biostatistics in the Department of Biomedical Sciences donated academic expertise to create new ways for analysing trial data. Dartmouth prioritizes team science, and this study includes a highly interdisciplinary team from the NCCC Programmes of Cancer Control and Cancer Epidemiology.
In the future, research is being conducted to uncover the mediating elements that contribute to enhanced survival and quality of life in patients and carers.
Materials provided by Norris Cotton Cancer Centre Dartmouth-Hitchcock Medical Centre, https://www.nia.nih.gov/, Note: Content may be edited for style and length.
M. A. Bakitas, T. D. Tosteson, Z. Li, K. D. Lyons, J. G. Hull, Z. Li, J. N. Dionne-Odom, J. Frost, K. H. Dragnev, M. T. Hegel, A. Azuero, T. A. Ahles. Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial. Journal of Clinical Oncology, 2015; DOI: 10.1200/JCO.2014.58.6362 Cite
Norris Cotton Cancer Centre Dartmouth-Hitchcock Medical Centre. “Early use of palliative care in cancer improves patients’ lives, outcomes for caregivers.” ScienceDaily. ScienceDaily, 15 April 2015. <www.sciencedaily.com/releases/2015/04/150415125528.htm>.
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