Early Palliative Care Improves Coping Strategies and Quality of Life

Perceptions of palliative care have begun to shift among health care providers and patients with cancer.

Often confused with hospice or “end-of-life” care, palliative care can be of great benefit to patients, especially those with advanced disease, who typically report having poorer quality of life, as well as more anxiety and depressive symptoms.

A study presented at the 2017 Palliative and Supportive Care in Oncology Symposium examined the effects of early-integrated palliative care on patients with advanced/incurable lung or non-colorectal gastrointestinal cancers.

“We wanted to look more at coping and figure out whether patients who participate in early-integrated palliative care have an improvement or reduction in the use of certain coping strategies,” said Jamie M. Jacobs, Ph.D., psychologist at Massachusetts General Hospital Cancer Center in Boston and author on the study.

The randomized study involved 350 patients — the majority of whom were women — who were all diagnosed within eight weeks. They were enrolled from May 2011 to July 2015.

Half of the patients were given early palliative care via in-person or telephone visits every three to four weeks. The other half were assigned to standard of care and given palliative care only upon request.

Quality of life, depressive symptoms and use of active or avoidant coping strategies were measured at baseline, 12 weeks and 24 weeks through a self-reported questionnaire.

“These palliative care visits involved a lot of managing symptoms and improving the ability to cope,” Jacobs said.

During the presentation, Jacobs cited a previous study that identified two different types of coping mechanisms. One is an active approach, where patients accept the situation they are in and seek out ways to healthily cope or improve their situation. The other approach focuses on avoidance and denial, and patients will prevent facing their diagnosis as much as possible and say things such as “this isn’t happening.”

“Patients who received early-integrated palliative care did report an increase in the use of these active coping strategies, compared to the usual care group,” Jacobs said. “This increase led to a better quality of life and a decrease in depressive symptoms.”

In the group that received palliative care, there was also a marginal decrease in the use of avoidance coping strategies.

Other factors that also led to better quality of life included symptom management, spiritual support and self-efficacy.

But, whatever the method, Jacobs emphasized that switching from avoidant to active coping strategies could be monumental for patients with cancer.

“There is really something about leading patients to active coping strategies that is improving outcomes,” she said.

Although researchers are still unclear about what, exactly, it is about palliative care that improves quality of life, the authors on this study wrote that early palliative care, “may improve quality of life and mood by providing patients with the skills to cope effectively with life-threatening illness.”