Earlier palliative care helps patients with advanced cancer to cope

Giving advanced cancer patients earlier access to palliative care services improves their quality of life and their satisfaction with the care they are getting, a new study suggests.

The research was led by researchers from Princess Margaret Hospital in Toronto and is published in the journal The Lancet.

The researchers randomly assigned 24 cancer clinics to offer regular care or early access to palliative care, which involved a range of services designed to help patients and their families cope with their illness.

Clinics in the regular care arm of the trial would have either not offered palliative care at all, or provided a referral to a
palliative care team in the last two months of life.

The researchers got the 461 patients in the study to assess their care and quality of life using questionnaires that are standardly used in this type of research.

Assessments at three months found few real differences between the two groups, but by four months those who had early access to palliative care scored higher for quality of life, symptom control and satisfaction with their care.

Lead researcher Dr. Camilla Zimmermann, head of the palliative care program at Princess Margaret Hospital, says there is a misconception about what palliative care is.

Many people believe it is the type of care hospitals offer when they have exhausted all medical options. They think it means that the oncology teams, having run out of cancer fighting tools, then hand off patients to people specialized in helping ease the final days of a dying person's life.

As a result, Zimmermann says, some people are reluctant to avail themselves of the help palliative care teams offer earlier in their cancer journey.

"That's what we find a lot in palliative care, is we're asked to see people right at the last minute," says Zimmermann, a palliative care specialist.

"And it's very difficult then to try to do all the work that you would have done slowly, in steps, earlier on. And it's very
traumatic and stressful for the patient and family to try to again scramble to get everything together to prepare."

She says palliative care teams — some of which have started to call the service they offer supportive care — collaborate with oncology teams to try to help patients through difficult treatments and the progression of their illness. For the palliative care team, that can mean providing access to home care and to assessments of the needs of the patient and his or her family, among other things.

The aims of both teams are the same, Zimmermann says — prolonging life and improving quality of life.

"We don't actually talk about advanced care planning or preparation until the patient is actually ready for that," she
says.

The study was funded by the Canadian Cancer Society Research Institute, the Ontario Ministry of Health and Long-Term Care and The Princess Margaret Cancer Foundation.