Echoes of published research

Brian McMichael has a post on the “echoes” of a RCT published in the NEJM in August 2010 showing that early palliative care improved quality of life, increased survival and reduced costs. By echoes, he means that this study served as the catalyst (along with others) that spurred a change in a policy statement by a specialty group, when the American Society of Clinical Oncology released a Provisional Clinical Opinion (background, the original study) that states that palliative care should be a fundamental part of cancer care for someone diagnosed with metastatic or advanced cancer.

Provisional Clinical Opinion Based on strong evidence from a phase III RCT, patients with metastatic non–small-cell lung cancer should be offered concurrent palliative care and standard oncologic care at initial diagnosis. While a survival benefit from early involvement of palliative care has not yet been demonstrated in other oncology settings, substantial evidence demonstrates that palliative care–when combined with standard cancer care or as the main focus of care–leads to better patient and caregiver outcomes. These include improvement in symptoms, QOL, and patient satisfaction, with reduced caregiver burden. Earlier involvement of palliative care also leads to more appropriate referral to and use of hospice, and reduced use of futile intensive care. While evidence clarifying optimal delivery of palliative care to improve patient outcomes is evolving, no trials to date have demonstrated harm to patients and caregivers, or excessive costs, from early involvement of palliative care. Therefore, it is the Panel’s expert consensus that combined standard oncology care and palliative care should be considered early in the course of illness for any patient with metastatic cancer and/or high symptom burden….

The provisional clinical opinion goes on to state:

…Strategies to optimize concurrent palliative care and standard oncology care, with evaluation of its impact on important patient and caregiver outcomes (eg, QOL, survival, health care services utilization, and costs) and on society, should be an area of intense research.

Figuring out to optimize the provision of palliative care alongside standard oncology care is the key. How to bring this evidence from a RCT to bear in a manner that helps patients, and hopefully improves the productive efficiency of care delivered to persons who are suffering from advanced cancer is important. Bit by bit, this is how we move ahead.

DT

About Don Taylor
Professor of Public Policy at Duke University (with appointments in Business, Nursing, Community and Family Medicine, and the Duke Clinical Research Institute). I am one of the founding faculty of the Margolis Center for Health Policy, and currently serve as Chair of Duke's University Priorities Committee (UPC). My research focuses on improving care for persons who are dying, and I am co-PI of a CMMI award in Community Based Palliative Care. I teach both undergrads and grad students at Duke. On twitter @donaldhtaylorjr

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