Early Palliative Care Improves QOL for Lung and GI Cancer Patients

The early integration of oncology and palliative care (EIPC) enhanced coping strategies-and improved quality of life (QOL)-for patients newly diagnosed with incurable lung or noncolorectal gastrointestinal cancer, according to a study published in the Journal of Clinical Oncology.

This secondary analysis of a nonblinded randomized clinical trial that compared EIPC with oncology care alone involved 350 patients who were recruited from May 2011 to July 2015 from outpatient clinics at the Massachusetts General Hospital Cancer Center in Boston.

Participants were primarily white (92.3%) and male (54.0%), with a sample mean age of 64.84 years. All received standard oncology care and were randomly assigned to receive EIPC (n = 175) or no EIPC (n = 175).

Patients completed self-assessments for QOL (Functional Assessment of Cancer Therapy-General), depressive symptoms (Patient Health Questionnaire-9), and coping (Brief COPE) at baseline and 24 weeks.

Those receiving EIPC met with a board-certified primary care physician or advanced-practice nurse within 4 weeks of enrollment in the study, and at least monthly until death. Visits focused on building rapport, managing symptoms, enhancing coping, improving understanding of illness and prognosis, assisting with treatment decisions, advance care planning, and preparing for the end of life.

The other patients met with a primary care clinician only at the request of the oncologist, patient, or family.

“Although numerous trials have demonstrated many benefits of EIPC for patients with incurable cancer, the key mechanisms by which this intervention model leads to improvements in outcomes are not understood,” wrote Jamie M. Jacobs, PhD, the study’s co-lead author, of the department of psychiatry at Harvard Medical School and a psychologist at Massachusetts General Hospital Cancer Center.

The researchers used linear regression models to test the effects of intervention on coping strategy usage, and then used mediation regression models with bias-corrected bootstrapping to “examine whether improvements in coping mediated the effects of early palliative care on patient-reported outcomes.”

The study showed EIPC significantly increased patient use of approach-oriented coping strategies (B = 1.09; SE = 0.44; P = .01) and slightly reduced the use of avoidant strategies (B = −0.44; SE = 0.23; P = .06) from baseline to 24 weeks.

Moreover, the increased use of approach-oriented coping and reduction in avoidant coping were linked with higher QOL and fewer depressive symptoms at 24 weeks.

“We now know that improved and more effective coping is one of the main ways that patients are benefiting from EIPC, and that this change in their coping, in a more adaptive and hopeful direction, is associated with improved QOL and mood,” wrote the researchers.

The researchers are now analyzing recordings of audio conversations between study participants and primary care providers, “to hone in” on how these interactions help patients cope better with their diagnoses, noted Jacobs.