Discussing Benefits of Palliative Care

Interview with Mary Lynn McPherson, PharmD

By Thomas G. Ciccone

A recent meta-analysis found that palliative care interventions were associated with statistically and clinically significant improvements in patient quality of life (QoL) and symptom burden.1

The study analyzed 43 randomized clinical trials, including data on 12,731 patients, with 35 of those trials using “usual care” as the control. While the associations with QoL and symptom burden were challenged by the heterogeneity of current research trials concerning palliative care,2 researchers found palliative care consistently associated with patient and caregiver satisfaction, as well as lower health care utilization.

“We’ve seen people who get involved with palliative care sooner definitely have a better quality of life, and they may live longer,” said Mary Lynn McPherson, PharmD, MA, BCPS, CPE, professor and executive director for advanced postgraduate education in palliative care for the University of Maryland’s School of Pharmacy in Baltimore, Maryland. The meta-analysis only included 1 study that had patient survival as a primary end point. In that study, Bakitas et al did find patient survival 1 year after palliative enrollment was better compared to patients who enrolled 3 months later.3

A similar study in 2010 found patients receiving early palliative care for their lung cancer showed better QoL and mood. And while patients who had “early” palliative care did receive less aggressive care at the end of life, their survival was still longer compared to patients who had standard care.4

Because palliative care is not concerned with patient survival, clinicians and patients may hold the negative perception that patients receiving palliative care will not live as long, something the data appears to disprove. Palliative care “is an added layer along with everything else,” said Dr. McPherson.  “We’re turning the tide from getting practitioners to stop thinking palliative or hospice care means ‘giving up.’ Even hospice care doesn’t mean we’re giving up,” she noted. “There may not be hope for a cure, but there is still hope that we can relieve the symptoms, relieve existential angst, and so on.

“But palliative care is not always about terminally ill patients. It’s all about quality of life—maximizing quality of life and maximizing outcomes, whether they be clinical or terministic,” she concluded.

     
  1. Kavalieratos D, Corbelli J, Zhang D, et al. Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis. JAMA. 2016;316(20):2104-2114.
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  3. Gaertner J, Siemens W, Daveson BA, et al. Of apples and oranges: lessons learned from the preparation of research protocols for systematic reviews exploring the effectiveness of specialist palliative care. BMC Palliat Care. 2016;15:43.
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  5. Bakitas MA, Tosteson TD, Li Z, et al. Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol. 2015;33(13):1438-1445.
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  7. 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;363:733-742.
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