Palliative Care Integrated With Chemotherapy Improves Survival in NSCLC

Kathy D. Miller, MD


August 31, 2010

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Hi. It's Dr. Kathy Miller, back again with another Medscape video oncology blog. So, by now you've probably seen the news reports, the emails, and the Twitter feeds about Dr. Jennifer Temel's amazing study[1] in non-small cell lung cancer. It was just published in the New England Journal of Medicine. She took patients with metastatic non-small cell lung cancer and randomized them to 2 different strategies of care: a group that [received standard care and a group that] got palliative care integrated with their chemotherapy at the same time. They just took the balance of primarily aggressive treatments with little palliative care and shifted that balance as their disease progressed. Of those patients who had what many of us would view as usual care (ie, chemotherapy and other treatments), when those were clearly not working, they shifted to palliative care.

What isn't surprising is that patients who got palliative care earlier had better quality of life, less depression, and less symptoms. What was surprising, perhaps, is that they lived longer, and not just a little bit longer -- over 2 and a half months longer. They lived longer even though they were less likely to avail themselves of aggressive end-of-life treatment. This study should be a model for how we take care of our patients with metastatic disease, regardless of the disease. Unfortunately, for virtually every patient that we treat with metastatic disease, this is not a curable situation. We know that and they know that, but being willing to incorporate palliative care up front means acknowledging that fact in a way that we perhaps have not always acknowledged, or at least not as honestly acknowledged as this treatment style requires. There's no excuse for not doing so. Patients do better, they have fewer symptoms, they live longer, and I would bet that it's cheaper or less expensive because of the less aggressive use of end-of-life measures that don't change the overall outcome.

The other thing that I noticed in this article that didn't get the press is that Dr. Temel is a junior investigator, and this work was supported by an American Society of Clinical Oncology [ASCO] Career Development Grant. Now, that's crucial. This is not a study testing a new drug. This is not a study with a sexy biologic or molecularly targeted intervention. This is not a study that was going to get pharmaceutical support, and it was the sort of study that was going to have a tough time getting funding from NIH [National Institutes of Health] or other granting agencies. This is exactly the sort of study and exactly the sort of investigator that our society and oncologists ought to invest in. This is a study that tells us how to take better care of the patients we serve, designed by a clearly intelligent and wonderfully trained young investigator.

So, congratulations, Dr. Temel, on this study. And congratulations to us as members of ASCO for supporting this sort of work. Perhaps as a tribute to our patients, it might be time for another contribution to the ASCO Cancer Foundation, because that's where the support for this sort of work comes from. I'll see you again in another blog soon.