By Stacey Kusterbeck
Palliative care consultations are known to affect end-of-life outcomes positively, including fewer in-hospital deaths. But despite evidence of these benefits, palliative care consults still are happening too late or not at all, found a recent study.1
Cameron Oswalt, MD, a medical oncologist at Duke University Medical Center, and colleagues analyzed how the timing and extent of palliative care involvement affects patient outcomes. Of 152 patients with metastatic non-small cell lung cancer (NSCLC), 53% never saw palliative care. Of the 47% who did see palliative care, 31% were seen early (within two months of diagnosis), 33% were seen intermediately (between two and six months), and 36% were seen late (after six months).
The researchers sought to better understand what patients with metastatic NSCLC experience at the end of life in today’s treatment landscape. A 2010 study demonstrated improved quality of life and survival in metastatic NSCLC with early palliative care involvement.2
“Since that point in time, there have been major changes in treatment options for patients with metastatic NSCLC. We were curious if the 2010 paper changed practice patterns, and if new treatment options for metastatic NSCLC impacted palliative care involvement,” says Oswalt.
In the cohort of patients with metastatic NSCLC, more than half never saw palliative care at all during their treatment course. “With evidence showing improved quality of life and survival, one might expect palliative care referrals to be a routine part of oncologic care,” says Oswalt.
Patients who received early palliative care had lower rates of aggressive end-of-life care, less frequent in-hospital death, and longer median time in hospice, compared to other groups.
“These variables have major impacts on quality of life and how patients and their families experience end-of-life care. This supports the ongoing importance of early palliative care discussions and involvement for this population,” concludes Oswalt.
Referring a patient to see palliative care is “incredibly complex,” says Oswalt. “There are multiple factors that impact successful palliative care contact — overall attitudes about the role of palliative care, family support, timing visits, and arranging travel, just to name a few.”
Some patients are adamant that they are not interested in palliative care. “There are so many preconceived notions about what palliative care is, or equating palliative care consultation to a hospice referral, which simply is not the case,” says Oswalt. On the other hand, some patients have very high disease burden and associated symptoms such as pain and shortness of breath, so they sense the need for palliative care support earlier.
When there is sufficient time for clinicians to explain the benefits of having palliative care as one component of treatment, Oswalt has found most patients are receptive to the idea.
“One way that ethicists could potentially help is by normalizing palliative care referrals, including them as part of standard metastatic NSCLC care, and engaging with patients, families, or caregivers early in the cancer journey to have some of these challenging conversations,” says Oswalt.
References
1. Oswalt CJ, Nakatani MM, Troy J, et al. Timing of palliative care consultation impacts end of life care outcomes in metastatic non-small cell lung cancer. J Pain Symptom Manage. 2024;68(4):e325-e332.
2. 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(8):733-742.
Palliative care consultations are known to affect end-of-life outcomes positively, including fewer in-hospital deaths. But despite evidence of these benefits, palliative care consults still are happening too late or not at all, found a recent study.
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