Including palliative care early in the course of cancer therapy for patients with advanced acute myeloid leukemia results in substantial improvements in quality of life, mood, and end-of-life care, according to a new study.
The findings demonstrate the benefits of early integration of palliative care for symptoms and stress into oncology care for patients with high-risk acute myeloid leukemia (AML), a highly aggressive cancer of the blood and bone marrow.
“This is the first multi-site randomized trial of an integrated palliative care intervention in patients with any blood cancer,” says Thomas W. LeBlanc, a medical oncologist and palliative care physician at Duke Cancer Institute and co-lead author of the study in JAMA Oncology.
Palliative care, which aims to prevent and relieve suffering by addressing physical, psychosocial, and spiritual concerns, has been shown to improve quality of life and reduce psychological stress for patients who undergo bone marrow transplants to treat blood cancers, but it has not been widely used for patients with AML.
In the trial, researchers randomly assigned 160 adults being treated for advanced AML at the four comprehensive cancer centers to the intervention or to usual care.
Patients assigned to the integrated palliative and oncology care (IPC) intervention met with palliative care specialists who focused on establishing a relationship with each patient, assessing their needs, treating their symptoms, understanding their goals and expectations for treatment, and helping make decisions about their therapy.
Patients assigned to usual care received supportive measures from their oncology team and were permitted to receive palliative care if they or their oncologist requested it. Only six of the 74 patients assigned to usual care received the extra care early in the course of their illness.
Patients who received IPC reported significantly better quality of life and lower levels of depression, anxiety, and PTSD at two weeks, and the benefits on all these measures continued through 24 weeks.
Of the patients who died, significantly more who had been assigned to IPC had discussed end-of-life care preferences with their clinicians, and significantly fewer underwent chemotherapy in the last few weeks of life. Chemotherapy at the end of life is not curative and is associated with significant side effects that can severely impair quality of life.
“Oncologists rarely consult palliative care for patients with AML, in part due to the lack of evidence for the role of early palliative care in this population,” LeBlanc says. “Our study clearly demonstrates the benefits of this type of care for these patients.”
Additional coauthors are from Duke. A Sojourns Scholars Leadership Program grant from the Cambia Health Foundation funded the work.
Source: Duke University