- Setting of study: "at the Princess Margaret Cancer Centre (Toronto, ON, Canada), between Dec 1, 2006, and Feb 28, 2011" 
- Sample size: "461 patients completed baseline measures (228 intervention, 233 control); 393 completed at least one follow-up assessment." 
- Results: Three months after the trial started, the intervention group had a significantly better quality of life and satisfaction of care; symptom severity was reduced although this difference wasn't statistically significant.

Summary of "Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial"

- Setting of study: Belgium, between April 2013 and Feb 2016
- Sample size: 468 patients were screened for eligibility, of whom 186 were enrolled. Of these 186, 94 were randomly assigned to standard care, and 92 were randomly assigned to early and systemic palliative care.
- Results: Early and systemic palliative care significantly improves the quality of life of patients having advanced cancer, though survival didn't improve.
- Limitations: Out of the 358 patients who were eligible, only 186 actually enrolled and were randomly assigned into one of two groups. Out of the enrolled patients, only about 70% completed the first follow-up assessment. Also, this trial is non-blinded.

Summary of "Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomised controlled trial"

- Better quality of life
- Usually better mood and symptom burden
- Maybe improved survival

University of Michigan - Ann Arbor

- Supportive care for patients with late-stage disease.
- Often underutilized/delayed
- Note: Palliative care is NOT hospice care though it includes hospice care.

Palliative Care (not hospice care)

Hui, D., & Bruera, E. (2016). Integrating palliative care into the trajectory of cancer care. Nature reviews. Clinical oncology, 13(3), 159–171. https://doi.org/10.1038/nrclinonc.2015.201

Integrating palliative care into the trajectory of cancer care | Nature Reviews | Clinical Oncology 

- Palliative-care programs at clinics/hospitals should be named as 'supportive care' rather than 'palliative care'
- Educate oncologists about palliative care.
- Educate palliative care specialists about oncology.
- Accelerate research and clinical trials on palliative care.


Palliative Care | Areas for Improvement

Palliative care involves managing the cancer, alleviating symptoms and addressing personal care needs, and managing comorbidities (see part a of the image below). Personal care needs include acute issues, chronic issues, psychosocial issues, and existential and/or spiritual issues (part b of the image).

Palliative Care Aspects

- Palliative care should be administered to patients with advanced-stage cancer (e.g., Stage IV cancer, aggressive and treatment-resistant Stage III cancers). 
- Patients who receive palliative care early (when they have advanced-stage cancer or have severe symptoms) have a better quality of life and possibly live longer than patients who receive palliative care only when they're at the end of life (i.e., ~ 30 days before dying).
- NOTE: Palliative care ≠ Hospice care.

Palliative Care Timing

- Palliative care teams need to be involved, although oncology teams and psychological teams also play a big role.

Learn Before

Related

Learn After