Camilla Zimmermann, MD
Traditionally, palliative care for patients with cancer is geared towards end-of-life measures, but a new study from the Princess Margaret Cancer Center in Toronto suggests patients who receive palliative care earlier in their cancer therapy report improved quality of life and greater satisfaction.
The findings demonstrate the benefits of cancer centers that provide early specialized palliative care in outpatient clinics, says principal investigator Camilla Zimmermann, MD, head of the Palliative Care Program at the University Health Network, and medical director of the Al Hertz Centre for Supportive and Palliative Care at the cancer center.
"Oncologists should be referring the patient earlier to outpatient palliative care teams to provide collaborative care because typically palliative care is provided much later in the disease process,” says Zimmermann who is also associate professor and holds the Rose Family Chair in Supportive Care in the University of Toronto faculty of medicine. “However, a lot of cancer centers and hospitals don’t provide outpatient palliative care teams, so the palliative care team has to make themselves relevant in the outpatient setting. Where it is available, oncologists still tend to refer quite late because of biases and stigmas associated with palliative care.”
The study involved assessing patients with advanced lung, gastrointestinal, genitourinary, breast, and gynecologic cancers whose prognosis was greater than six months. Quality of life, symptom control, satisfaction with care, and difficulty with medical interactions were measured.
All participants completed a baseline survey while receiving the same clinical care over four months. However, the early intervention group received formal monthly consultation with the palliative care team in a specialized outpatient clinic. These 228 patients also received regular telephone follow-up. When the study ended, patients were offered continued follow-up in the outpatient palliative care clinics.
Although the intervention group reported a worse status at baseline, the study showed a trend for improvement in quality of life at three months and clinically meaningful improvement at four months. Patients had undergone cluster randomization, meaning the whole clinic would receive palliative care or not said Zimmermann. “This was a practical issue because it would be more palatable to patients and oncologists to participate,” she said. “The downside is selection bias,” she added.
Similarly, patient satisfaction with care improved substantially at both three and four months in the early palliative care group, while it deteriorated in the control group.
“In the community setting, oncologists and hematologists should attend to the type of issues that palliative care teams can address like symptom control, attention to emotional and spiritual needs, and family needs to help patients and families cope,” said Zimmermann.