Cancer Patients Enrolled In Clinical Trials Do Better When They Receive Palliative Care

Tuesday, May 21, 2002

Researchers argue quality-of-life issues need more attention in clinical trials

(ORLANDO, Fla.) -- Contrary to common wisdom, cancer treatment is not disrupted -- but may be enhanced -- when interventions designed to improve patients' physical, functional, emotional and social well-being are provided during clinical trials, according to a study by researchers at the UC Davis School of Medicine and Medical Center.

The study was presented here Tuesday morning at the annual meeting of the American Society of Clinical Oncology.

"In the past, it's been an either-or situation: Seriously ill patients have been told they can have a clinical trial or they can go home and focus on quality of life," said Frederick J. Meyers, professor and chair of internal medicine at UC Davis School of Medicine and Medical Center and director of the West Coast Center for Palliative Education and Research.

"In our opinion, that's not an acceptable choice. Why can't patients have both?"

To answer this question, Meyers and his colleagues compared two groups of cancer patients enrolled in phase I and phase II clinical trials of investigational chemotherapy treatments. All of the patients had a prognosis of less than one year to live.

One group of patients received the investigational chemotherapy protocol only. Patients in the other group received palliative care in addition to the investigational treatment. Quality-of-life assessments were administered monthly to all patients.

In the palliative care group, a nurse and social worker made regular home visits to patients, and also accompanied patients to their clinic appointments. At these visits, the nurse and social worker emphasized symptom management, emotional support and discussion of end-of-life issues.

At the end of the seven-month study, patients in the treatment-only group scored lower on quality-of-life measurements than they had when they entered the study, while patients in the palliative care-plus-treatment group scored higher. In addition, patients in the palliative care group were more likely to finish all of their chemotherapy cycles. And more palliative-care patients were referred to hospice.

"Patients, families and physicians can address palliative care and disease-directed treatment simultaneously, without disruption of care," said Meyers, who is also medical director of the hospice program at UC Davis Medical Center.

The study was supported by a grant from the Robert Wood Johnson Foundation's Promoting Excellence in End of Life Care initiative.

According to Meyers, combining investigational and palliative care would represent a significant change in the culture of most cancer centers -- but the change is needed. "Quality of life issues often go un-addressed by cancer centers around the country," he said.

"This model of simultaneous investigational and palliative care emphasizes patient choice -- and is superior to the current, sequential approach," he concluded.

With a $2.5 million National Institutes of Health grant, Meyers will now conduct a larger, multi-institutional study of this simultaneous care model. That study will get under way later this year.

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