At the virtual 2021 Community Oncology Alliance (COA) Annual Conference, Morvarid Rezaie, DO, HMDC, FACOI, a palliative care physician at The Center for Cancer & Blood Disorders in Fort Worth, TX, discussed the integration of palliative care into community oncology practice.
Dr Rezaie emphasized the importance of integrating palliative care early in a patient’s disease course. “Solid palliative care unfortunately gets incorporated late into a patient's care, whenever it comes to advanced stage cancer, because it has such an impact potential to improve quality of life and even reduce use of medical services, especially toward the end of life,” she said. “We really need to try to incorporate it early on.”
She highlighted two studies demonstrating the benefits of integrating palliative care.
The first study, published in The New England Journal of Medicine in 2009, compared early palliative care integrated with standard oncologic care vs standard oncologic care alone in patients with newly diagnosed non-small cell lung cancer. At baseline, there were no significant differences in quality of life or mood between the two groups.
The study found that those who received early palliative care had significantly higher scores on the Functional Assessment of Cancer Therapy – Lung scale, the Lung Cancer Subscale, and the Trial Outcome Index. In addition, fewer patients exhibited signs of depression, and experienced significantly longer survival compared with the standard care group (11.6 vs 8.9 months; P = .02).
The second study, ENABLE II, compared palliative care intervention vs usual care for patients with newly diagnosed advanced cancer. This study incorporated National Consensus Project Clinical Practice Guidelines for Quality Palliative Care.
Palliative care intervention implemented a chronic care model and included case management, patient education, patient empowerment, and distress assessment. The usual care arm allowed use of all oncologic and support services without restrictions.
The primary outcome measures were quality of life, symptom intensity, and mood. At baseline, there were no significant differences in these measures between the two groups.
This study found that patients in the intervention group were more likely to have functionality improvement, lower symptom severity, higher quality of life scores, and lower rates of depression.
There is a common misconception that palliative care is the same as end-of-life care. ASCO now recommends providing palliative care to all patients with advanced cancer early in their disease course along with active treatment. In addition, NCCN also recommends introducing palliative care to all patients as an integral part of comprehensive cancer care at the time of diagnosis.
In order to successfully integrate palliative care into community oncology practice, Dr Rezaie highlighted a few needs: community and provider awareness; supportive partnerships; evaluation of the impact of palliative care; and ensuring its sustainability.—Janelle Bradley