Cancer patients that receive palliative care earlier in their treatment demonstrate higher satisfaction, better symptom management and an increased survival rate, according to a study in the American Journal of Managed Care (AJMC).
The study, published in December, 2016, looked to discover if any benefits were realized by oncology patients who received palliative care in an outpatient setting. Researchers also looked at how patients and their families reacted to the care plan by having a team speak with them throughout treatment.
Don’t confuse palliative care with hospice
Patients and families may often confuse palliative care and hospice care, according to Shirisha Reddy, a medical director at Aetna.
“A lot of patients have the perception that palliative care is hospice and flat-out say, ‘no,'” Reddy said. “Palliative care is really critical for all medical care when patients are dealing with serious health care issues.”
Jamie Fertal, a medical director for Aetna’s National Care Management, added that confusion between the two treatment methods can be a barrier.
“There is lack of knowledge and misunderstanding of the two,” Fertal said. “Many families have no experience and don’t know what it is. There is a nebulous kind of fear about it being synonymous with giving up.”
Palliative care can be offered earlier in the treatment or disease process, to help patients manage symptoms and enjoy an improved quality of life, according to the National Cancer Institute. A patient may continue curative treatment while they receive palliative care.
Palliative care focuses on quality of life and symptom management
Hospice is a form of palliative care and is given to oncology patients when cancer therapies are no longer controlling the disease, according to the National Cancer Institute.
“Early integration of palliative care can be a cost saver, but much more importantly than that, it can avoid hospitalizations with quality of life in mind,” Fertal said.
Prior to joining Aetna, Fertal worked as the director of the largest outpatient palliative clinic in Orange County, California.
Studies have shown palliative and hospice care resulted in increased life expectancy for oncology patients. A 2010 study in the New England Journal of Medicine found patients with non-small-cell lung cancer lived an average of nearly two months longer if they received palliative care.
Researchers in an earlier study found patients with the most common terminal diagnoses lived 20 to 69 days longer when they received hospice care.
“A person can start receiving palliative care and eventually be transitioned into hospice if the treatments aren’t working,” Reddy emphasized. “Both types of care do extend a patient’s life expectancy.”
The mind-body connection
Fertal added palliative care recognizes the mind-body connection and the value of treating the physical, emotional and spiritual self to improve overall quality of life.
“Reducing pain and symptoms allows you to continue the activities that are important to you longer, which helps people to remain purposeful in life- this is a huge psychological benefit,” she said. “There’s the emotional benefit of taking control of your destiny; choosing to plan for your death and choosing to die on your own terms and reaching out to get some finality and closure. These things make people live longer.”
The National Quality Forum defines palliative care as a plan that prevents and treats suffering and addresses “physical, intellectual, emotional, social and spiritual needs.” It also helps aid with patient autonomy, giving them the opportunity to tell clinicians what kind of treatment they want or may not want to receive.
“You’re improving the quality of life for the patient,” Reddy said. “It’s very patient-centered and very family-centered.”
A patient with advanced cancer will receive chemotherapy, but palliative care will focus on making their quality of life better. A team will work to help manage the symptoms related to the patient’s disease and chemotherapy, Reddy said.
Hospice care focuses on quality of life and occurs when treatment does not work or when patients choose to stop curative treatments.
“There’s a conversation about what the goal of care is and what the purpose is,” she explained.
If the patient has a terminal condition and an average of six months to live, they may forego all treatment. They may receive care in hospice, with the focus on improving their quality of life.
Palliative care can help patients, families
The AJMC study references other studies that have shown evidence of patient benefits when receiving palliative care. These patients had better symptom control, lower psychological distress, lower depression rates and higher quality of life.
“I see amazing things happen,” Fertal said of palliative care. “Typically after the first encounter, I see relief of some kind for the patients – even if it’s just being heard and reassured that symptoms will be better managed.”
It can also help save costs because palliative care teams work with patients and their families to create patient-specific treatment plans. Researchers of the AJMC study found “aligning treatment with patient goals can also save costs via reduced hospitalizations and by avoiding expensive treatments and procedures” the patient does not want.
Higher quality of life, less depression and better symptom control
It can be stressful for families when a loved one is being treated for cancer. The National Cancer Institute states family members can also benefit from palliative care by helping them cope and giving them support.
Listening to patients and family members early in the treatment process is important, Reddy said, and working with them can lead to better outcomes.
“Having conversations often and early with patients is critical. Patients that have that discussion have lower levels of depression and higher quality of life scores.”