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19 August 2010

Palliative care boosts survival

A new study suggests that starting palliative care early in the treatment of patients with advanced lung cancer can boost their quality of life and lengthen their lives.

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Palliative care is often thought of as a medical measure of "last resort".

But a new study suggests that starting palliative care early in the treatment of patients with advanced lung cancer can boost their quality of life, lift their mood and lengthen their lives.

Researchers compared 74 patients who received standard medical care with 77 patients who had palliative care added to standard care right after diagnosis.

"The patients who received palliative care in addition to standard care had marked improvement in quality of life, a 50% lower rate of depression and they lived 2.5 months longer than patients not receiving palliative care early," said study author Dr Jennifer S. Temel, an assistant professor of medicine at Harvard Medical School and a thoracic oncologist at Massachusetts General Hospital in Boston.

"In this disease, two months is a significant amount of time," she said. "We were all surprised with the magnitude of the impact." The study is published in the New England Journal of Medicine.

Many misconceptions

Patients and their families have misconceptions about palliative care, said study co-author Dr Vicki Jackson, acting chief of the palliative care service at Mass General. "I think one common misconception is that palliative care is a treatment only for patients in the final days and weeks of their lives," she noted.

Not so, she said. "Palliative care is a service - a group of clinicians who help patients with serious illness focus on quality of life and help them live as well as they can, as long as they can," she explained.

For instance, palliative care can help patients deal with pain, anxiety and loss of appetite. A typical palliative care team, Jackson said, includes doctors, social workers, nurse-practitioners and chaplains.

"Palliative care is not hospice," Jackson said. Hospice services are typically launched when people likely have six months or less to live and for whom a cure is not possible.

The study

In the study, all patients had non-small cell lung cancer that had spread. The researchers began seeing them while they were outpatients, though over the course of the study there were hospitalisations.

Patients completed a questionnaire about their mood and quality of life when they started the study and again 12 weeks later. Symptoms of depression reported in the palliative care group were about half those reported in the standard care group, even though the rate of new antidepressant medicine prescriptions was similar for the groups.

Patients in the palliative care group lived an average of 11.6 months, while those in the standard care group lived less than nine months. This was true, the researchers said, even though the palliative care group received less aggressive medical treatments.

"This is the first definitive study that palliative care not only improves quality of life for patients and families, but helps [patients] live longer," said Dr R. Sean Morrison, president of the American Academy of Hospice and Palliative Medicine.

The findings, he said, suggest palliative care should be the standard, launched whenever a serious or life-threatening illness is diagnosed. (August 2010)


(Copyright © 2010 HealthDay. All rights reserved.)

 
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