Far from giving up on life, critically ill patients who were randomly assigned to receive early palliative care had less depression, and lived significantly longer than those assigned to receive standard care.
That's the finding of a clinical trial published in Thursday's New England Journal of Medicine. Researchers found that among patients with end-stage metastatic non-small-cell lung cancer, early palliative care also led to significant improvements in quality of life compared to patients who received standard care.
They also were more likely to have specified their end-of-life resuscitation preferences, which led to less aggressive care at the end very end of life, reduced chemotherapy, and longer hospice care.
"Given the trends toward aggressive and costly care near the end of life among patients with cancer, timely introduction of palliative care may serve to mitigate unnecessary and burdensome personal and societal costs," the authors concluded.
The 12-week trial was conducted by Jennifer S. Temel, MD, a lung cancer specialist and researcher at Massachusetts General Hospital and colleagues at Columbia University Medical Center and Yale University, and took place at Massachusetts General Hospital.
Of the 151 patients enrolled, 107 completed the trial. Patients assigned to early palliative care were found to have a better quality of life than patients assigned to standard care. And, despite the fact that fewer patients in the early palliative group received aggressive care at the end of life, (33% versus 54%), those in the early palliative group lived more than two months longer (11.6 months vs. 8.9 months).
"There's an inaccurate perception among the American public that hospice means you've given up," said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization. "Those of us who have worked in the field have seen firsthand how hospice and palliative care can improve the quality of and indeed prolong the lives of people receiving care."
Those randomized to the early palliative care group met with members of a palliative care team, which included board-certified palliative care physicians and advanced-practice nurses at least monthly in the outpatient setting until they died. Patients, at their own discretion, or that of the oncologist or palliative care provider could have additional visits with the palliative care service.
The patients received special attention to their physical and psychosocial needs and were assisted with decisions regarding treatment and coordinated care.
Patients who received standard care were not scheduled to meet with the palliative care service unless the patient, family member, or oncologist specifically requested it.
Patients in both groups continued to be treated by an oncologist throughout the study period.
Writing in an accompanying editorial, Amy S. Kelley MD and Diane E Meier, MD of the Department of Geriatrics and Palliative Medicine at the Mt. Sinai School of Medicine in New York, called Temel's study an important step in confirming the beneficial outcomes of a simultaneous care model that provides both palliative care and disease-specific therapies beginning at the time of diagnosis."
They said it "shifts a long-held paradigm."
"Perhaps unsurprisingly, reducing patients' misery may help them live longer. We now have both the means and the knowledge to make palliative care an essential and routine component of evidence-based, high-quality care for the management of serious illness."