Palliative Care May Help Advanced Cancer Patients Live Longer
Experts say such care should be expanded to include people who aren’t yet in hospice.
Palliative care helps relieve stress, anxiety, and depression in cancer patients. Getty Images
Outpatient palliative care can improve the quality of life for people with advanced cancer.
It can also improve length of life, according to a Tulane University study published in Annals of Behavioral Medicine.
Palliative care focuses on managing symptoms such as pain as well as appetite and sleep problems.
It also addresses issues like stress, anxiety, and depression that can go along with a cancer diagnosis and treatment.
Palliative care has been in transition for 20 years, the researchers say.
Traditionally, this type of care was suggested as patients approached death.
Now, it’s offered after diagnosis of advanced cancer while patients are still being treated for the disease.
Care teams can consist of doctors, nurses, mental health professionals, nutritionists, pharmacists, and clergy.
It can involve weekly or monthly in-person visits as well as phone support.
Studies show that both physical and psychological outcomes are improved with palliative care.
What the research says
Michael Hoerger, assistant professor of psychology, psychiatry, and oncology at Tulane, led the research.
The meta-analysis consisted of eight randomized clinical trials published from 2001 to 2017.
These studies looked at the impact of outpatient palliative care on quality of life and survival.
It included more than 2,000 people with advanced cancers, mostly lung and gastrointestinal cancers.
The team found that 56 percent of patients randomized to receive outpatient palliative care were still alive after one year.
In comparison, 42 percent of those who received typical care were still alive.
Those who received palliative care lived more than four months longer than those who didn’t.
“The survival benefit was comparable to what is often observed in the context of a breakthrough drug trial,” Hoerger said in a press release.
The study authors acknowledge that their conclusions may not be pertinent to all patients with advanced cancer or other serious illnesses.
They suggest that more high-quality studies of palliative care are needed, saying their findings may help to destigmatize palliative care.
Marlon Saria, PhD, RN, is an advanced practice nurse researcher at the John Wayne Cancer Institute at Providence Saint John’s Health Center in California. He wasn’t involved in the study.
Saria told Healthline there are several important things to note about the research.
Although key components were similar, the palliative care programs studied varied in terms of program leadership, composition, and how services were delivered.
But all focused on symptom management, psychosocial concerns, and coping with advanced illness.
And adjustments weren’t made for types of cancers.
“There are cancers that have an average survival less than one year. Therefore, the impact of palliative care extending survival beyond one year would be greater in those patients,” Saria said.
“There is increasing evidence that palliative care needs of patients with different types of cancers vary, and the focus of care may need to be more tailored to the type of cancer,” he continued.
Saria notes that many patients in the studies were white, in their 60s or 70s, and received treatment in a geographically restricted region of North America.
He says it’s important to know if the observed benefits related to survival have to do with the setting.
“No research is perfect. Having said all that, this paper significantly contributes to what we know about palliative care. The challenge is to translate the findings so that palliative care is integrated earlier in the course of cancer treatment,” Saria said.
Confusion over palliative care
According to Saria, oncologists are increasingly integrating palliative care into their practice. But some still don’t take advantage of these services for their patients.
“Some of them will argue that they provide adequate symptom management from the day of diagnosis. For these patients, palliative care as a ‘value added service’ may not be consulted until later in the course of treatment,” he said.
And not all patients with advanced cancer are anxious to receive palliative care.
One problem might be confusion over what palliative care is and how it compares to hospice care.
Saria points out that online dictionaries may define palliative care as “care for the terminally ill and their families, especially that provided by an organized health service.”
But using the words “terminally ill” may cause fear or apprehension in some patients.
Serious illness may be a better term, Saria says.
“It is important to note that patients receiving palliative care can continue to receive aggressive cancer treatment,” he said.
Palliative care can be used at any point during cancer treatment.
“Yes, palliative care is involved in hospice. But in the hospice setting, curative (aggressive) treatment is no longer offered,” Saria said.
He explains that some cancer treatments, such as chemotherapy or radiation, can be offered in hospice care. This is to help manage a symptom, such as pain or obstruction from the tumor, with the goal of providing relief, not a cure.
“I have had patients and family members get provoked or upset with the suggestion of inviting palliative care to address their unmet needs. I also have patients and family members proactively ask for palliative care,” he said.
Hearing about palliative care from patient and family support groups is contributing to the rise in use of these services, adds Saria.
He says there are two philosophies about the use of the term “palliative care.”
One is to keep calling it that until patients and providers realize the true definition. The other is to call it something else, most commonly “supportive care.”
Need for palliative care
Who needs palliative care, and when?
Saria says anyone having symptoms related to cancer or its treatment should start asking questions about palliative care.
He explains there are some symptoms that should be expected with treatments such as chemotherapy, immunotherapy, and radiation. And oncology practices are competent in managing these symptoms.
But sometimes symptoms and side effects don’t respond to treatment.
That’s when a palliative care team can help.
And it’s not only for the cancer patient. It’s also helpful for their families, Saria advises.
He wants patients to understand, though, that there’s no single standardized model of palliative care.
“It would also be helpful to offer this service to patients before they experience the symptoms. If all patients were introduced to palliative care earlier, it normalizes palliative care (even if they don’t yet need it) and may help distinguish it from end-of-life or hospice care,” Saria said.