Early Palliative Care Can Lessen Hospital Stays, Improve Well-Being
It is never too early for a patient diagnosed with mesothelioma — or most any cancer — to start consulting with a palliative care specialist, according to a recent study.
The message from researchers at the University of Texas MD Anderson Cancer Center in Houston: The sooner, the better.
Results from the study show early palliative care referrals and outpatient referrals were associated with fewer hospitalizations, emergency room visits, intensive-care admissions and hospital deaths compared to those on an inpatient basis.
Palliative care focuses on pain relief, symptom reduction and quality of life improvement, and it’s usually recommended for patients with a poor diagnosis or a late-stage cancer.
David Hui, M.D., oncologist at MD Anderson Cancer Center and one of the study’s authors, told Asbestos.com that palliative care is often neglected or delayed, unnecessarily depriving cancer patients of valuable and available resources, researchers said.
“Earlier palliative care is generally a good thing,” said Hui, who is also one of the nation’s leaders in palliative care research. “There is more and more evidence to support the need for it, and the benefits that come from it.”
Study Revealed Significant Differences
Researchers published the study titled, “Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients,” in the June issue of the journal Cancer. There was a commentary on it in the July/August edition of CA: A Cancer Journal for Clinicians.
The study included 366 patients in the Houston area who died of advanced cancer between Sept. 1, 2009 and Feb. 28, 2010, and had at least one palliative care (PC) consultation.
According to the report, 33 percent had an early (greater than three months before death) PC referral, 46 percent were first seen on an outpatient basis, and 54 percent were first referred to inpatient care.
Early and outpatient PC referrals showed a reduction in hospital stays and deaths. In addition to those benefits, earlier outpatient palliative care also was associated with facilitating end-of-life discussions with patients. Researchers said a previous study showed these types of early discussions improved a patient’s end-of-life care.
The current study also indicates outpatient palliative care teams help in detecting and managing patients’ pain and depression, improving patients’ access to psychological services, introducing such services to patients’ homes, and helping patients avoid emergency department visits.
You saw quite a difference in the two groups. It was a little surprising how strong the association was between early palliative care and better end-of-life outcomes,” Hui said. “This added even more evidence to support the need for more resources for this kind of care.”
Availability of Outpatient Care
Hui believes there are a number of reasons why more than half of all cancer patients don’t take full advantage of palliative care.
- Lack of Availability: While an earlier study showed more than half of the cancer centers in the U.S. designated by the National Cancer Institute (NCI) provide outpatient palliative care, only 22 percent of those not associated with the elite designation, but also spread across the nation, offer the service. “There also are not enough palliative care doctors and nurses,” Hui said. “Sometimes, it’s just a matter of resources being available.”
- Misunderstandings Among Doctors: Too many oncologists and medical professions don’t understand or appreciate all the benefits that early palliative care can bring, and they are slow to advise patients to seek it. Some are not comfortable talking to patients about it.
- Stigma: Patients are discouraged to talk about palliative care because it often carries a stigma that you are giving up the fight against cancer and just preparing to die.
Developing a Better Understanding
Hui believes that part of providing palliative care is understanding the disease at every stage and knowing how it will affect a person physically and mentally.
He says palliative care should be integrated alongside standard cancer therapies from the day of diagnosis so the benefits from each type of treatment can work together and provide a smoother experience for cancer patients.
“People have this idea that palliative care is just about end-of-life issues, but it’s not. It’s about symptom management, about facilitating communications and about helping you make decisions about your care,” Hui said. “It’s not about giving up.”