Surprise, or maybe not – Palliative Care Extends Life, Study Finds
In a study that sheds new light on the effects of end-of-life care, doctors have found that patients with terminal lung cancer who began receiving palliative care immediately upon diagnosis not only were happier, more mobile and in less pain as the end neared — but they also lived nearly three months longer.
The findings, published online Wednesday by The New England Journal of Medicine, confirmed what palliative care specialists had long suspected. The study also, experts said, cast doubt on the decision to strike end-of-life provisions from the health care overhaul passed last year.
“It shows that palliative care is the opposite of all that rhetoric about ‘death panels,’ ” said Dr. Diane E. Meier, director of the Center to Advance Palliative Care at Mount Sinai School of Medicine and co-author of an editorial in the journal accompanying the study. “It’s not about killing Granny; it’s about keeping Granny alive as long as possible — with the best quality of life.”
Actually i am not surprised. One of my favorite quotes, attributed to Osler, goes, ""The good physician treats the disease; the great physician treats the patient who has the disease"
I fear that to often sub-specialists focus on the disease more than the patient. They do not do this because they do not care, rather they live reading and talking about disease. They are, almost by definition, disease-focused.
We had a situation during my father's illness where a medication, prescribed to slow his metastatic cancer, caused significant side effects which greatly hampered my father's quality of life. He decided (and as a physician son I concurred) that he should stop the medication. Fortunately my father had no symptoms from the cancer; unfortunately he had symptoms from a medication.
According to my father, the oncologist did not understand his decision to discontinue the medication and appeared angry about that decision.
Now perhaps I am exaggerating, and I do not really know the interchange. But I have seen too many patients with physicians who focus on slowing the disease "at all costs".
Having a good primary care physician involved can work. Having excellent palliative care can work.
Palliative care works because it is patient focused. And after all, our job is to treat patients.
Bravo to the group who did this study.
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Thanks for this post- clinicians like me have observed this phenomenon for years- patients who refuse or stop standard treatment for their cancer (or their renal failure or their heart disease) often way out-live their prognosis. I took care of a lovely woman with adrenal cell carcinoma for the last 3 years- her oncologist (and 2 others for 2nd and 3rd opinions) said her prognosis- with treatment- would be 1 year, without it weeks to months. She wanted none of it after a terrifying hospitalization for the original resection (untreated pain in a major NYC teaching hospital- not mine). She stayed home with her incredibly supportive and loving family, and I managed her pain, shortness of breath, and fatigue. With low doses of long and short acting opioids and gradually increasing doses of steroids she lived _3_ years post diagnosis. Hospice got involved in the ast 7 months and she almost had to be discharged from hospice for failing to die on time (within the 6 month window). Yes- we need more studies on impact of simultaneous palliative care along with usual care for other kinds of cancer and other kinds of illnesses and other settings, like nursing homes. But this is pretty strong evidence. Palliative care is no longer nice to have, no longer optional. For physicians who pride themselves on evidence based medical practices on behalf of our patients, It is required .
Thanks for posting about this article. I like the Osler quote and there is a similar one by Francis Peabody often attributed to Osler.
"the secret to caring for the patient is caring for the patient."
I think disease focused medicine has led to great advances in the past 40 years but there are some burdens it has brought along with it. I think we are at the beginning of a rebalancing era.
For other people interested in deeper analysis of the study check out my co-blogger Lyle's analysis at Pallimed and Alex at GeriPal.
http://www.pallimed.org/2010/08/game-changer-early-palliative-care-for.html
http://www.geripal.org/2010/08/palliative-care-prolongs-life.html
The question I have with this study is how do we actually pay for good palliative care. The reimbursement structures to pay for time and thinking are so poor as you well know.
This is a 'must read' for those interested in palliative medicine. http://bit.ly/aoAg3H
I believe that oncologist have a bias in suggesting chemotherapy because thats what they know and thats what they do for a living. I have been in two teaching hospitals and I do not think that there training involves a paliative care rotation (happy to be corrected if wrong).
My problem is that when I see the dying patient in an ICU, a lot of patients still believe in chemotherapy because they have been made to believe in it and they share a good rapport with the oncologist…a palliative care consultant is also seen as an outsider in such situations.
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