The American Society of Clinical Oncology recently recommended that doctors offer palliative care alongside standard medical treatment for people diagnosed with metastatic cancers and those who have severe or multiple symptoms resulting from cancer.
The recommendation, called a provisional clinical opinion, helps healthcare providers navigate and put into place changes suggested by newly published research.
The ASCO opinion marks a significant shift in cancer treatment standards. It recognizes palliative care, specialized medical care focused on providing relief from the symptoms, pain and stress of serious illness, as an important part of complete medical care.
Reason for the Recommendation
Current standard of care does not meet the needs of many people with chronic and life-threatening illness, affecting quality of life, as well as the quality and cost of treatment. Those with metastatic disease make up a large part of this group, with nearly half living for years beyond their initial diagnosis.
Until recently, results from studies demonstrating the benefits of palliative care were not available. But one recent phase III trial showed palliative care, when combined with standard care or as the main focus of care, improved symptoms and quality of life, reducing the burden for caregivers. This trial was randomized and controlled, meaning participants were randomly assigned to receive the standard treatment (no palliative care) or the study treatment (adding palliative care) to test the safety and effectiveness of the additional healthcare services. This study, bolstered by similar findings in six other trials, led to ASCO’s recommendation.
Understanding Palliative Care
Palliative care is often misunderstood as hospice care, specialized medical care including medicine and treatment to manage symptoms, control side effects and promote comfort toward the end of life. Palliative care is everyday medical care that ensures the best possible quality of life right now.
Palliative care does not replace regular treatment, but adds to it. It is used throughout the course of illness and may include pain management, treatments or procedures that relieve symptoms and side effects. Palliative care treats physical symptoms, also addressing the emotional, social and spiritual concerns that impact overall quality of life. Using palliative care does not mean you are preparing for end of life; it means making the most of your life in the moment.
To learn more about palliative care, LBBC offers a free publication in our Metastatic Breast Cancer Series called Understanding Palliative Care.
Results of the Studies
The trial prompting the ASCO recommendation focused on non-small cell lung cancer. Six earlier trials were also reviewed, supporting palliative care as maintaining or improving mood, satisfaction with treatment and quality of life for those with metastatic cancers. Those studies included people with a variety of metastatic diseases, including breast cancer.
In the lung cancer trial, the palliative care group had significantly fewer depression symptoms and less need for aggressive end-of-life care. This group better understood their prognosis, or outcome of illness, and received 41 percent less chemotherapy near the end of life than the group that did not receive palliative care. The participants who received palliative care lived, on average, two months longer than those who did not, an exciting finding that requires further research.
Researchers concluded early palliative care in patients with metastatic cancer significantly improved quality of life, mood and survival, despite less aggressive end-of-life measures, compared to standard treatment.
What This Means for You
If you are newly diagnosed with metastatic breast cancer or being treated for it, you may want to speak with your treatment team about including palliative care in your treatment. If palliative care is already part of your treatment, you may want to explore further options that will support you and enhance your quality of life.
Smith, T., et. al. American Society of Clinical Oncology Provisional Clinical Opinion: The Integration of Palliative Care into Standard Oncology Care. February 2012 Journal of Oncology Practice