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In this single-centre unblinded study performed in Massachusetts over 3 years, 151 outpatients with newly diagnosed metastatic non-small cell lung cancer and with a performance status of 0–2 were randomised to either standard oncological care alone or to standard care plus early palliative care.
The study groups were broadly similar and the results were analysed on an intention-to-treat basis at 12 weeks; 14% of patients in the standard care group were referred to palliative care at the discretion of the treating physician and were included in the standard care analysis. Patients in the early palliative care group had significantly higher quality of life scores as measured by various health-related quality of life scores at 12 weeks, and lower depression scores as measured by the Hospital Anxiety and Depression scale.
By the time of the final analysis, 70% of the study population had died. Of these, more of the standard care group had received invasive end of life care such as chemotherapy or emergency hospitalisation. More of the early palliative care group had resuscitation and end of life decisions documented in the notes and the early palliative care group had more days of hospice care. Despite these differences, the early palliative care group had a longer duration of survival than the standard care group although the study was not powered or designed to measure this outcome.
This study did not measure the palliative care received but, as the authors suggest, the survival difference is comparable to trials of platinum-based chemotherapy. The results are intriguing and hint towards an improvement in quality and length of life, with an associated reduction in expensive and invasive end of life treatment. At a time of rationalisation of services in the NHS and spiralling drug costs, this small study supports a role for earlier palliative care involvement.
▶ Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733–42.
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