Let's Stop Claiming That Palliative Care Improves Survival

by Drew RosielleHospice and palliative care community, I'm calling for a moratorium on all blanket, unqualified claims that hospice and palliative care improve survival.Let's just stop doing this.There has never been any actual evidence that palliative care (PC) interventions improve survival in patients, but since thelandmark Temel NEJM 2010 RCT of early outpatient palliative care for lung cancer patients showed a clinically and statistically significant improvement in longevity in the PC arm, I have heard and all read all sorts of statements by palliative people and all sorts of others (hospital executives, policy makers, oncologists) in all sorts of venues (local talks, national talks, webinars, newspapers, etc) along the lines of'palliative care helps patients with cancer live longer.'I've even heard the results discussed as evidence that hospice helps cancer patients live longer.We should have never done this, and if you're still doing it, please stop.To begin with,'palliative care'isn't a single thing. It's not like studying enoxaparin, or nivolumab, or olanzapine, where you can to a reasonable extent assume that if it helps patients in Lille, France or Boston, MA, it will likely help your similar patients in your practice wherever. Palliative care is just not like that - it is complex, and local conditions are very important, and it is impossible to make broad generalizations about PC in general from a single study at a single institution. Some PC research involve...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: lung cancer palliative palliative care quality of life rosielle temel The profession Source Type: blogs

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CONCLUSIONS: The model accurately predicted changing cancer risk for low performance status and severe symptoms over time.PMID:34128429 | DOI:10.1177/02692163211019302
Source: Palliative Medicine - Category: Palliative Care Authors: Source Type: research
CONCLUSIONS: About 50% of patients with advanced lung cancer admitted to palliative care services had relevant insomnia. Several factors associated with insomnia have been identified and should prompt physicians for a careful examination and subsequent treatment.PMID:34120396 | DOI:10.1111/ijcp.14521
Source: Clinical Lung Cancer - Category: Cancer & Oncology Authors: Source Type: research
Palliat Support Care. 2021 May 4:1-7. doi: 10.1017/S1478951521000468. Online ahead of print.ABSTRACTLung cancer (LC) is the most frequent and deadly neoplasm in the world, and patients have shown a tendency to have more emotional distress than other cancer populations. Dignity Therapy (DT) is a brief intervention aimed to improve emotional well-being in patients facing life-threatening illness.OBJECTIVE: To analyze the effect of DT on anxiety, depression, hopelessness, emotional distress, dignity-related distress, and quality of life (QoL) in a group of Mexican patients with stage IV LC undergoing active medical treatment ...
Source: Palliative and Supportive Care - Category: Palliative Care Authors: Source Type: research
This study compares distress experienced by lung cancer patients and their FC during the year following the diagnosis.METHODS: A prospective cohort study of 206 patients recently diagnosed with inoperable lung cancer (participation rate 79.5%) and 131 FC (participation rate 63.6%) was conducted in an ambulatory oncology clinic in Quebec City (Canada). They completed validated questionnaires regarding their personal and psychological characteristics (Hospital and Anxiety Depression Scale-HADS), in the first months after the diagnosis of lung cancer and after 6 and 12 months. Univariate, bivariate, and linear mixed models we...
Source: Palliative and Supportive Care - Category: Palliative Care Authors: Source Type: research
CONCLUSION: MCA lowered patient-reported information needs, but did not have other effects. MCA contributed to tailored communication, because an adequate level of information and orientation set the basis for patient-centered care.IMPLICATIONS FOR PRACTICE: By addressing relevant issues at predefined times, the MCA is a tool to provide individual patient-centered care facilitating the timely integration of palliative care for patients with a limited prognosis. Needs of lung cancer patients have to be assessed and addressed throughout the disease trajectory. While specific topics are relevant at particular times for all pa...
Source: The Oncologist - Category: Cancer & Oncology Authors: Source Type: research
CONCLUSIONS: The majority of advanced lung cancer patients and their family caregivers have serious concerns from diagnosis, which is associated with their psychological distress. The spectrum of concerns alters over the disease trajectory, warranting efficient tailored care and support for both groups immediately after diagnosis.PMID:33761790 | DOI:10.1177/02692163211001721
Source: Palliative Medicine - Category: Palliative Care Authors: Source Type: research
by Fitzgerald Jones, Ho, Sager, Rosielle and MerlinHave you ever been so distressed by a perspective piece that it kept you up at night? The type of rumination that fills you with so much angst that you have no choice but to act. This is exactly how we felt when we read theAAHPM Quarterly Winter 2020 Let ’s Think About It Again.1 (member paywall)The column, which is structured as a sort of written debate in which two authors argue a clinical question, describes a case of a 45-year-old man with severe substance use disorder (SUD) recently diagnosed with extensive-stage small-cell lung cancer. He was offered ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: ftigerald jones ho merlin rosielle sager Source Type: blogs
by Fitzgerald Jones, Ho, Sager, Rosielle and MerlinHave you ever been so distressed by a perspective piece that it kept you up at night? The type of rumination that fills you with so much angst that you have no choice but to act. This is exactly how we felt when we read theAAHPM Quarterly Winter 2020 Let ’s Think About It Again.1 (member paywall)The column, which is structured as a sort of written debate in which two authors argue a clinical question, describes a case of a 45-year-old man with severe substance use disorder (SUD) recently diagnosed with extensive-stage small-cell lung cancer. He was offered ...
Source: Pallimed: A Hospice and Palliative Medicine Blog - Category: Palliative Care Tags: ftigerald jones ho merlin rosielle sager Source Type: blogs
Abstract BACKGROUND: Inflammation may contribute to the high prevalence of depressive symptoms seen in lung cancer. "Sickness behavior" is a cluster of symptoms induced by inflammation that are similar but distinct from depressive symptoms. The Sickness Behavior Inventory-Revised (SBI-R) was developed to measure sickness behavior. We hypothesized that the SBI-R would demonstrate adequate psychometric properties in association with inflammation. METHOD: Participants with stage IV lung cancer (n = 92) were evaluated for sickness behavior using the SBI-R. Concomitant assessments were made of depression...
Source: Palliative and Supportive Care - Category: Palliative Care Authors: Tags: Palliat Support Care Source Type: research
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