Podcast: Early palliative care for adults with advanced cancer

For some patients with cancer, their illness is so advanced when it is detected that anticancer treatments might not be able to help. However, these patients might still benefit from palliative care and in a new Cochrane Review from June 2017, Markus Haun from Heidelberg University Hospital in Germany and colleagues investigated the effects of providing palliative care early after the diagnosis of advanced cancer. He tells us what they found in this podcast.

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John: Hello, I'm John Hilton, editor of the Cochrane Editorial unit. For some patients with cancer, their illness is so advanced when it is detected that anticancer treatments might not be able to help. However, these patients might still benefit from palliative care and in a new Cochrane Review from June 2017, Markus Haun from Heidelberg University Hospital in Germany and colleagues investigated the effects of providing palliative care early after the diagnosis of advanced cancer. He tells us what they found in this podcast.

Markus: Even if cancer is diagnosed at a late stage when it might no longer respond to treatment, some patients might still wish to try anticancer treatments knowing that they might experience the adverse effects without obtaining any benefits. If these treatments don’t help, the patient might then be offered palliative care towards the end of life. However, patients might also be able to receive palliative care a lot earlier, beginning at the time of, or shortly after, their diagnosis of advanced cancer. This early palliative care, which is often combined with anticancer treatment such as chemotherapy or radiotherapy, involves empathetic communication with patients about their prognosis, advance care planning, and symptom assessment and control.
It’s important to have reliable information on the effects of this strategy in order to support decision making and we did this review to assess the evidence on whether early palliative care might help with quality of life, symptom intensity, depression, and survival among patients, when compared with usual cancer care alone.
We were able to include seven randomised trials involving just over 1600 participants, which showed that early palliative care may increase quality of life slightly and decrease symptom intensity to a small degree. The effects on survival and depression were unclear. However, little information was provided on adverse effects and the overall certainty of the evidence was very low to low because of the small number of studies, how they were done, and differences between them.
Therefore, although our review indicates that early palliative care interventions may have more beneficial effects on quality of life and symptom intensity among patients with advanced cancer than usual or standard cancer care alone, we have to interpret the current results with caution. On a more positive note, we also found a further 10 studies that still need to be checked carefully and there are at least 20 ongoing randomised trials in this area. The upcoming results from these studies may increase the certainty of our findings and lead to improved decision making. In the meantime, we need to remember that early palliative care is a newly emerging field, and well-conducted studies are still needed that clearly describe the components of this type of care, and report on its effects, both beneficial and harmful.

John: If you would like to read more about the evidence currently available from the seven randomised trials in Markus’ review, to look at the studies that will contribute to future updates or to watch out for those updates, you can find the review online. Just search 'Cochrane and early palliative care' to link to it.

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