Palliative Care Helps

People with a type of lung cancer called non-small cell who received palliative care early in the course of their disease lived longer and experienced less mental distress than patients who didn't receive such care, a study in the New England Journal of Medicine concludes.

Are you familiar with the term 'palliative care?'  Rick defines it from a  clinical perspective in this week's podcast, but one dictionary I consulted defines palliation as a means to relieve or lessen without curing, and as such, has quite a role in medicine, especially at the end of life.  Palliative care differs in essential ways from hospice care, however, because helping people to live with constraints or consequences of health conditions doesn't always mean helping them to a humane death.

A total of 151 patients who were diagnosed with non-small cell lung cancer were enrolled in this study.  Survival after diagnosis is usually about one year.  Approximately half the patients received standard care while the other half received early palliative care.  Such care included careful assessment of physical and psychosocial symptoms, coordinating care based on the patient's specific condition, helping establish goals of treatment and helping with decision making regarding treatment.

While the numbers are fairly small, the outcomes are impressive.  Fewer patients in the early palliation group received aggressive care at the end of life, they were more likely to have documented their resuscitation preferences, they had a higher quality of life and fewer symptoms of depression than those assigned to standard care, and they lived an average of 11.6 months after diagnosis, compared to 8.9 months for the standard care group.

The authors write that such measures are likely to become even more important as closer scrutiny of health care costs takes place, but what I like about this study is it suggests that early implementation of strategies to improve quality of life for people with terminal illness is a win-win, actually allowing them to survive happier, longer.  To me, that's the most important allocation of healthcare resources.

Other topics this week include another way cool study in the NEJM on tai chi and relief of fibromyalgia symptoms, and two heart studies in JAMA: disappointing results from using a sponge to avoid infections following cardiac surgery, and delays in treatment for heart attack and their impact on survival.  Until next week, y'all live well.

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