Integrated Palliative/Oncology Care Feasible for Advanced Lung Cancer Patients

By Scott Baltic

NEW YORK JUN 25, 2007 (Reuters Health) - There appears to be no reason not to integrate palliative care with standard oncology care for patients newly diagnosed with terminal lung cancer, according to a recent study by researchers from Massachusetts General Hospital, Boston, and Dana-Farber Cancer Institute, Boston.

The study, published in the June 10 issue of the Journal of Clinical Oncology, followed 50 patients who had recently (8 weeks or less previously) been diagnosed with advanced non-small-cell lung cancer and who received integrated palliative and oncology care in an ambulatory setting.

The integrated care approach included monthly meetings with a palliative care team and monthly questionnaires on mood and on quality of life, all for 6 months.

Lead author Dr. Jennifer S. Temel, at Massachusetts General Hospital, Boston, and colleagues report that not only did patient participation exceed expectations, but all participants who survived longer than 6 months chose to continue to meet regularly with the palliative care team after the study concluded.

"The traditional dichotomy between cancer-directed therapy and palliative care hinders the provision of comprehensive care for patients and their families," the team writes.  "Symptom management and psychosocial support for patients with advanced cancer and their families must be a part of the continuum of care, not just once life-prolonging therapies fail."

Dr. Temel contends that the obstacles to providing integrated care for terminal patients are probably mostly perceived, not real.

"These patients have a lot of symptoms, a lot of distress; they have, unfortunately, a limited life expectancy," she told Reuters Health. "Why wouldn"t we focus on (palliative care) from the start?

The problem, Temel said, is that many care providers have traditionally thought that focusing on palliative care or symptom management is not compatible with aggressive treatment, "or would take away a patient"s hope."

Temel conceded that integrated care can be a challenge for centers that don"t have palliative-care providers, but she added that many centers probably have nurse practitioners who might have expertise in this area.

"The most significant finding is that an integrated model of care is feasible. That has not been shown before," she said.

A follow-up study is comparing patients receiving integrated care versus those getting standard oncology care, to see what the benefits are for both patients and families, Temel said.

"The most important take-home message is that it"s OK to talk about palliative care and symptom management, even with patients who are newly diagnosed. It doesn"t take away patients" hope or drive, and probably provides better care for them."

SOURCE:

• J Clin Oncol 25:2377-2382