1. Fuerst, Mark L.

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CHICAGO-Introducing palliative care shortly after a cancer diagnosis results in better quality of life and fewer depression symptoms for family caregivers, according to a new study.

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The study (Abstract 10131) was featured in a press briefing and was presented at the 2016 American Society of Clinical Oncology Annual Meeting.


"The benefits of early palliative care extend beyond patient outcomes and positively impacts family caregivers. Early integration of palliative care for patients with newly diagnosed lung and GI incurable cancers leads to improvement in family caregivers' depression and aspects of quality of life," said lead author Areej El-Jawahri, MD, Director of Bone Marrow Transplant Survivorship Program at Massachusetts General Hospital Cancer Center, Boston.


"This study suggests that early palliative care creates a powerful positive feedback loop in families facing cancer. While patients receive a direct benefit from early palliative care, their caregivers experience a positive downstream effect, which may make it easier for them to care for their loved ones."


This is the first study to show that early palliative care alone for a patient with cancer can have a strong impact on family caregivers, El-Jawahri said.


Palliative Care Studied

The researchers conducted a Phase III randomized trial of early palliative care integrated with oncology care versus oncology care alone for 350 newly diagnosed patients with incurable lung and gastrointestinal cancers and 275 family caregivers, who were relatives or friends who would likely accompany the patient to clinic visits. The patients with family caregivers were randomized to receive usual oncology care (138 patients) or usual care in addition to palliative care (137 patients).


The intervention entailed at least monthly patient visits with palliative care from the time of enrollment. Family caregivers were not required to attend these visits, but about half of them did.


The focus of the palliative care visits was on symptom management, coping, establishing rapport, and "illness understanding." The most common symptoms addressed were pain and fatigue, while the most common coping topics addressed were redirecting hope, coping counseling, and behavioral coping.


Palliative care, which was delivered by a multidisciplinary team of doctors, nurses, social workers, and psychologists, can provide an "extra layer of support" for patients, El-Jawahri said.


The researchers used the Medical Outcome Study Health Survey Short Form-36 to examine quality of life and the Hospital Anxiety and Depression Scale to examine mood at baseline and at weeks 12 and 24, and also examined changes in quality of life and mood at those time points.


At 12 weeks, caregivers of patients receiving palliative care reported significantly lower depression symptoms. Vitality and social functioning improved for caregivers of patients receiving early palliative care, but decreased for caregivers of patients receiving standard care. There were also non-significant improvements in other quality of life domains, including bodily pain and physical-role functioning.


At 24 weeks, caregivers of patients assigned to early palliative care continued to report fewer depression symptoms, but no statistically significant difference was observed in the other measures. "Improvement in family caregiver outcomes appear to be partially mediated by improvement in patients' quality of life," she said, adding that the researchers are conducting additional analyses to better understand this effect.


A separate analysis of the impact of early palliative care on patients in this study, also to be presented at the ASCO Annual Meeting, found early integration of palliative care with standard treatment was associated with improved patient quality of life, decreased depression, and more frequent end-of-life discussions.


Caregivers & Cancer

"Family caregivers play a critical caregiving role for patients with cancer. The substantial caregiving burden negatively impacts their quality of life and mood. Early integration of palliative care improves quality of life and mood in patients with advanced cancer," said El-Jawahri.


She added: "Family caregivers play a critical role throughout the illness trajectory. We truly see the importance of early palliative care for patients, and palliative care also plays an integral role in the improvement of quality of life and mood in patients."


Julie M. Vose, MD, MBA, ASCO President and Chief of the Oncology/Hematology Division, Department of Internal Medicine, University of Nebraska Medical Center in Omaha, commented: "Caregivers provide critical support for patients with cancer, but it can take a heavy toll. This study shows that early palliative care, although designed for and directed at patients, can also help ease the burden on their caregivers. This insight contributes to the large and growing body of evidence supporting early palliative care for patients with advanced cancers."


Mark L. Fuerst is a contributing writer.