QOL Boost Seen From Early, Systematic Palliative Care in Patients With Advanced Solid Tumors

February 22, 2018

In a Belgian study, integration of palliative care as part of cancer care increased the quality of life of patients with advanced malignant solid tumors.

Early and systematic integration of palliative care as part of cancer care increased the quality of life (QOL) of patients with advanced malignant solid tumors in Belgium, according to the results of a study published in Lancet Oncology.

“To our knowledge, this is the first time that early and systematic integration of palliative care in oncological care has improved the overall quality of life of patients with advanced cancer, of whom most were offered psychosocial support by professionalised caregivers,” wrote Gaëlle Vanbutsele, MSc, of Vrije Universiteit Brussel and Ghent University, Brussels, Belgium.

Research has suggested that the benefit of early palliative care is due to increased psychosocial support; however, in Belgium, psychosocial care is a standard part of oncologic care. Therefore, in this trial the researchers wanted to determine if early and systematic integration of palliative care into their protocols and standards for psychosocial oncologic care provided any added benefit.

The study included 186 patients aged 18 years or older with advanced cancer due to a solid tumor and an estimated life expectancy of 12 months. Patients were randomly assigned to early and systematic integration of palliative care or standard oncologic care alone. Standard oncologic care included interaction with medical specialists, psychologists, social workers, dietitians, and specialist nurses. The primary endpoint was change in global health status/QOL at 12 weeks.

Of the patients assigned to early palliative care, 89% had at least one consultation with a palliative care nurse and 27% had at least one consultation with a palliative care physician. In the standard care group, 18% of patients consulted with a palliative care nurse and 1% had a consultation with a palliative care physician.

Study compliance at 12 weeks was similar between the intervention (71%) and standard of care (72%) groups. Patients assigned to early and systematic palliative care had a significantly higher overall QOL score at 12 weeks compared with standard of care, based on both the EORTC QLQ C30 score (61.98 vs 54.39, respectively; P = .03) and the McGill Quality of Life Questionnaire (7.05 vs 5.94, respectively; P = .0006).

“Several other patient-reported outcomes were improved in patients who had early and systematic integration of palliative care,” the researchers wrote. “Cognitive functioning and existential wellbeing were significantly improved at 12 weeks, as were physical functioning and role functioning at 18 weeks.”

No differences in mood, including depressive symptoms and anxiety, or in overall survival were found between the two study groups.

“Conclusions regarding the mechanisms of early palliative care cannot be made with the current study design. However, we believe that improved overall quality of life might be related to the differences in the focus of oncology and palliative care,” the researchers wrote. “Oncology professionals and psychosocial interventions mostly focus on symptom burden caused by the disease and treatment, whereas palliative care professionals mainly focus on a patient’s quality of life-eg, spending time with family and friends, or partaking in day-to-day activities,” they added.