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Palliative Care at Point of Cancer Surgery May Not Be Beneficial
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Palliative care — which focuses on quality of life — did not significantly improve outcomes in patients when delivered at the point of oncology surgery, highlighting the need to better understand when the best time to provide the service would be.
In recent years, there has been an abundance of research regarding the potential benefits of palliative care in oncology care. However, with a limited number of palliative care clinicians, it is essential to determine in which setting patients with cancer would benefit most from these supportive services.
According to recent research published in JAMA Surgery, palliative care does not improve patient outcomes when given at the point of cancer surgery.
“Over the past two decades, research has shown that patients with cancer benefit from seeing palliative care specialists earlier in their treatment. This has resulted in palliative care moving further upstream in the course of cancer care, but palliative care specialists are in short supply, so we can’t just have palliative care specialists see everyone,” study author Dr. Myrick “Ricky” Shinall Jr., associate professor of surgery and medicine at the Vanderbilt University Medical Center, said in an interview with CURE®.
Palliative care focuses on improving quality of life for people with serious diseases, though it may not significantly improve outcomes at the point of cancer surgery, research showed.
Palliative care — which can be provided at any point during the cancer continuum and regardless of prognosis — focuses on improving the quality of life and alleviating suffering for patients with serious illnesses. It can focus on symptom management, psychological or spiritual stress, caregiver support or difficult decision-making, Shinall explained.
According to a study published by the American Society of Clinical Oncology in 2022, there are approximately 6,000 board-certified palliative care specialists, with more than 1.6 million people diagnosed with cancer and nearly 600,000 dying from the disease annually.
The study involved 235 adults who were undergoing major abdominal surgery for cancer. Some were randomly assigned to receive specialist palliative care, which included a consultation with a palliative care doctor or nurse practitioner, and then palliative care visits twice weekly during the hospital stay, three follow-up visits or phone calls between hospital discharge and their 90-day postoperative period and an inpatient palliative care visit if the patient was readmitted to the hospital. The other patients on the study received usual care.
The researchers on the study assessed physical and functional quality of life, anxiety, caregiver burden and survival among the two groups. Findings showed no significant improvements for the palliative care group, and no added stress or burden for those who received palliative care, either.
“At the start of the trial, we could really envision (outcomes) going either way. Based on the prior research in oncology, it would not have surprised us for the intervention to improve outcomes. On the other hand, surgery is so different from other cancer treatments like chemotherapy or stem cell transplant that we knew that the benefits of palliative care might not translate,” Shinall said. “We had to do the trial to find out.”
However, Shinall did mention that if a patient believes he or she would benefit from palliative care, that very well might be the case, and they should discuss options with their provider.
“If a patient thinks that they might like to see a palliative care specialist, that’s probably a good indication that they would benefit from palliative care,” he said.
He also mentioned that future research needs to focus on better defining the patient groups that would benefit most — and least — from these services.
“We really need a better understanding of what patient characteristics define those who would benefit from specialist palliative care so that we can best target palliative care to the patients who need it most,” he concluded.
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