Nick Mulcahy

May 19, 2016

CHICAGO — It is a scenario many oncologists have witnessed: a patient with an incurable cancer is surrounded by caring family members and close friends who are increasingly stressed out and depressed.

But it does not have to be this way, according to results from a novel randomized controlled trial.

When palliative care was added to standard cancer care shortly after a cancer diagnosis, quality of life was better for family caregivers and they reported fewer symptoms of depression, said lead investigator Areej El-Jawahri, MD, from the Massachusetts General Hospital Cancer Center in Boston.

"This study suggests that early palliative care creates a powerful positive feedback loop in families facing cancer," Dr El-Jawahri explained in a press statement. "While patients receive a direct benefit from early palliative care, their caregivers experience a positive downstream effect, which may make it easier for them to care for their loved ones."

This is the first study to show that early palliative care can have a strong "positive" impact on family caregivers, Dr El-Jawahri said during a presscast held in advance of the American Society of Clinical Oncology (ASCO) 2016 Annual Meeting.

 
Early palliative care creates a powerful positive feedback loop in families.
 

She noted that a previous study, ENABLE III, examined direct interventions (i.e., phone calls and education) with family caregivers and found a beneficial effect. That study was presented at the 2014 ASCO annual meeting, as reported by Medscape Medical News.

In their study, Dr El-Jawahri and her colleagues assessed patients with incurable lung and gastrointestinal cancers and 275 of their family members, friends, or loved ones who were identified as the primary caregiver.

The active intervention was a monthly palliative care meeting between medical staff and the advanced cancer patient. Although the primary caregiver was not required to attend the meetings, about 50% did so regularly, Dr El-Jawahri reported.

The primary caregiver was evaluated at enrollment and at 12 and 24 weeks using standard questionnaires for quality of life (Medical Outcomes Study Health Survey Short Form-36) and mood (Hospital Anxiety and Depression Scale).

At 12 weeks, caregivers of patients receiving early palliative care reported significantly fewer symptoms of depression than caregivers of patients receiving standard care. And vitality and social functioning were also significantly better for caregivers of patients receiving early palliative care

At 24 weeks, caregivers of patients receiving early palliative care continued to report fewer symptoms of depression, but for the other measures, the differences were not significant.

The specifics of the outcomes will be released during an oral presentation at the meeting.

"This study points out that we have so many ways to help patients and their families through treatment," said presscast host and ASCO President Julie Vose, MD, MBA, from the University of Nebraska in Omaha.

"Palliative care helps the patient and the family caregivers," Dr Vose explained.

A separate study of the impact of early palliative care on the patients in this cohort will be presented at the meeting.

The early integration of palliative care with standard treatment was associated with multiple benefits for the patients themselves, the researchers found, including improved quality of life, decreased depression, and more frequent end-of-life discussions.

This study was funded by the National Institutes of Health. Dr El-Jawahri and Dr Vose have disclosed no relevant financial relationships. A number of the study coauthors report financial relationships with industry.

American Society of Clinical Oncology (ASCO) 2016 Annual Meeting: Abstract 10131. To be presented June 6, 2016.

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

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