A Very Short Brief on the Benefits of Palliative Care

The Benefits of Palliative Care: Beyond relief from suffering

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This brief addresses the following question:

What benefits are there from palliative care beyond the usual relief from pain and suffering?

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The benefits of palliative care beyond that of relieving pain and suffering are starting to come to light. Not only is palliative care showing signs of extending the life of terminally ill cancer patients by approximately 3 months, a feat that would be heralded by pharmaceutical companies had it been a drug, it is increasingly being seen as care which is to be used during the time that a person is getting treatment for a disease, in addition to when there are no useful treatments available.

Differing from hospice care, which focuses typically on the final 6 months or less of care and where death is known, palliative care is not limited to the end of life care, the hallmark of hospice. It has been rightly stated that “while all care that is provided by hospices can be considered palliative care, not all palliative care is delivered in hospices.” Indeed, palliative care within an integrated model of medical care is provided at the same time as curative or life-prolonging treatments.

Benefits of palliative care outside that of the normal relief of suffering are highlighted in the following excerpt:

Studies have shown that palliative care services improve patients’ symptoms, allow patients to avoid hospitalization and to remain safely and adequately care for at home, lead to better patient and family satisfaction, and significantly reduced prolonged grief and post traumatic stress disorder among bereaved family members. Palliative care also lowers costs, and reduces rates of unnecessary hospitalizations, diagnostic and treatment interventions, and non-beneficial intensive care. Particularly when initiated early in the disease course, palliative care also improves clinical and quality of care outcomes, and possibly survival.[1]

With the benefits of early palliative care starting to emerge there have been calls to change the paradigm for management of patients with advanced life threatening diseases. Not only is earlier and increasingly thorough assessments of options, goals, and preferences being called for, calls are beginning to being made for tailored care done throughout the course of illness.

Palliative care offers older people with advanced chronic illness, structured discussions, specialized care coordination, palliative care teams which increase patient and family satisfaction, a combination of medications and complementary therapies, and targeted interventions and individualized support. All of the above have been shown to increase family caregiver satisfaction. In one study by Marie Bakitas, patients with advanced cancer and who were enrolled in a palliative-care program reported “higher quality of life and better mood than patients not enrolled in the program.”

The data on the beneficial aspects of early palliative care is starting to come. Four particular studies of note are mentioned below.

  1. In a landmark study, patients with newly diagnosed metastatic non–small cell lung cancer who were randomly assigned to early palliative care integrated with standard oncologic care had a better quality of life (QOL), less depressive symptoms, and longer median survival than did those who were assigned to oncologic care alone. The ambulatory palliative care assessment in this trial focused on symptom management, patient and family coping, and illness understanding and education. In a later analysis, patients receiving early palliative care received the same number of chemotherapy regimens as did those in the control group but they were less likely to have chemotherapy continued close to death and more likely to enroll in hospice for a longer duration.
  2. Another randomized controlled trial (the ENABLE II trial) demonstrated higher scores for QOL and mood in patients with any life-limiting cancer (prognosis of approximately one year) who received psycho-educational palliative intervention in addition to standard care.
  3. A third randomized controlled trial of ambulatory palliative care compared to usual care demonstrated that comprehensive outpatient palliative care in patients who continue to pursue disease modifying treatment improves symptom management and patient satisfaction.
  4. In yet another trial, patients with late-stage chronic obstructive pulmonary disease and heart failure who were randomly assigned to in-home palliative care as compared to usual care reported greater satisfaction with care and were more likely to die at home.[2]

 

[1] Diane E. Meier et al. “Palliative care: Benefits, services, and models of care” pg.2

[2] Diane E. Meier et al. “Palliative care: Benefits, services, and models of care” pg.2-3

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