Thursday, September 09, 2010

Palliative care may prolong survival

Here's a study that probably surprised many folks, but it shouldn't have. The boosters of palliative care haven't done a very good job of defining it. As a result there is a tendency to conflate palliative care with hospice and other models of end of life care (see Bob Wachter's post entitled My Patients Are Dying… And I’ve Never Been Prouder).

The findings:

Among patients with metastatic non–small-cell lung cancer, early palliative care led to significant improvements in both quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival.

Although there was less aggressive care at the end of life, palliative care was given alongside standard oncology care.

This from the accompanying NEJM editorial adds clarity:

Palliative care is provided both within the Medicare hospice benefit (hospice palliative care) and outside it (nonhospice palliative care). Nonhospice palliative care is offered simultaneously with life-prolonging and curative therapies for persons living with serious, complex, and life-threatening illness. Hospice palliative care becomes appropriate when curative treatments are no longer beneficial, when the burdens of these treatments exceed their benefits, or when patients are entering the last weeks to months of life.1

So there is a branch of palliative care administratively designated as “hospice palliative care” but nonhospice palliative care seems to be the larger piece.

DB weighs in here.

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