Patients In Palliative Care Group Research Articles

Palliative care and COVID-19: acknowledging past mistakes to forge a better future.

COVID-19 induces complex distress across physical, psychological, and social realms and palliative care (PC) has the potential to mitigate this suffering significantly. To describe the clinical characteristics and outcomes of COVID-19 patients with an indication of PC, compared to patients who had no indication, in different pandemic waves. This retrospective multicenter observational cohort included patients from 40 hospitals, admitted from March 2020 to August 2022. Patients who had an indication of palliative care (PC) described in their medical records were included in the palliative care group (PCG), while those who had no such indication in their medical records were allocated to the non-palliative care group (NPCG). Out of 21,158 patients, only 6.7% had indication for PC registered in their medical records. The PCG was older, had a higher frequency of comorbidities, exhibited higher frailty, and had a higher prevalence of clinical complications and mortality (81.4% vs. 17.7%, p < 0.001), when compared to the NPCG. Regarding artificial life support, the PCG had a higher frequency of dialysis (20.4% vs. 10.1%, p < 0.001), invasive mechanical ventilation (48.2% vs. 26.0%, p < 0.001) and admission to the intensive care unit (53.6% vs. 35.4%, p < 0.001). These differences were consistent across all three waves. A low proportion of patients received PC. Patients in PCG were more fragile, had more clinical complications, and had a higher mortality. On the contrary to our expectations, they received more artificial life support in all three waves. Taken together, these findings suggest that decisions regarding PC indication were made too late, within a context of end-of-life and therapeutic failure.

A retrospective analysis evaluating the benefit of early palliative care for patients with advanced pancreatic adenocarcinoma.

30 Background: Patients with advanced pancreatic carcinoma exhibit from the diagnosis and beyond severe clinical symptoms dominated by pain and weight loss, hampering quality of life. A recent study in metastatic lung cancer have shown a clear advantage of early palliative care in both quality of life and mood (Temel JS, et al. N Engl J Med 2010;363:733-42). Methods: Based on these data, we conducted a monocentric retrospective study including patients with advanced pancreatic cancer newly diagnosed and treated according with standard guidelines. The aim of this study was to determine the contribution of early palliative care visits (with supportive care physicians) on disease control symptoms, quality of life and overall survival. Results: From January 2006 to December 2010, 157 patients, PS 0, 1 or 2, with newly diagnosis of advanced pancreatic cancer were retrospectively enrolled. 126 patients (80.3 %) received at least one chemotherapy line. Out of 157 patients, 64 (40.7%) were seen in our palliative care department. Demographic patient characteristics between the two groups were well balanced; palliative care versus non palliative care: median age, 66.2 vs 66.7 years; PS 0,1 51 (79.5 %) vs 73 (79.7 %) ; male 34 (53.1 %) vs 47 (50.5 %) ; metastatic disease 39 (60.9%) vs 51 (54.8 %). Patients in the palliative care group showed more clinical symptoms at diagnosis, especially pain (73.4% patients in palliative care group versus 50.5%; p=0.004). They received less aggressive care at the end of their life: interruption of chemotherapy earlier (1.7 months before death versus 1.2 months) and less number of chemotherapy cycles in the month before death (22.7% versus 43.5%, p=0.042). However, no significant difference was observed for overall survival between both groups: 7.5 months in palliative care group versus 6.9 months (p=0.99). Conclusions: This study underlines the need of a multidisciplinary approach in advanced pancreatic cancer, promoting palliative care started initially at the diagnosis. It deserves to be completed by a largest prospective randomized study including a quality of life analysis.

Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer

Patients with metastatic non-small-cell lung cancer have a substantial symptom burden and may receive aggressive care at the end of life. We examined the effect of introducing palliative care early after diagnosis on patient-reported outcomes and end-of-life care among ambulatory patients with newly diagnosed disease. We randomly assigned patients with newly diagnosed metastatic non-small-cell lung cancer to receive either early palliative care integrated with standard oncologic care or standard oncologic care alone. Quality of life and mood were assessed at baseline and at 12 weeks with the use of the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale and the Hospital Anxiety and Depression Scale, respectively. The primary outcome was the change in the quality of life at 12 weeks. Data on end-of-life care were collected from electronic medical records. Of the 151 patients who underwent randomization, 27 died by 12 weeks and 107 (86% of the remaining patients) completed assessments. Patients assigned to early palliative care had a better quality of life than did patients assigned to standard care (mean score on the FACT-L scale [in which scores range from 0 to 136, with higher scores indicating better quality of life], 98.0 vs. 91.5; P=0.03). In addition, fewer patients in the palliative care group than in the standard care group had depressive symptoms (16% vs. 38%, P=0.01). Despite the fact that fewer patients in the early palliative care group than in the standard care group received aggressive end-of-life care (33% vs. 54%, P=0.05), median survival was longer among patients receiving early palliative care (11.6 months vs. 8.9 months, P=0.02). 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. (Funded by an American Society of Clinical Oncology Career Development Award and philanthropic gifts; ClinicalTrials.gov number, NCT01038271.)