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Palliative Care May Offer Survival Benefits

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123Donna View Drop Down
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    Posted: Feb 28 2012 at 5:05pm
Palliative Care May Offer Survival Benefits

By Bryan Tutt

Photo: Drs. Eduardo Bruera and David Hui
Drs. Eduardo Bruera, (left) and David Huiof the Department of Palliative Care and Rehabilitation Medicine at MD Anderson discuss a case.

Recent studies indicate that palliative care, which has been shown to improve quality of life in patients with advanced cancer, may also help patients live longer.

Patients with cancer or any life-threatening disease face a broad array of physical, spiritual, emotional, and financial problems. “Palliative care has a body of knowledge that can help patients, families, and even the primary care physicians treating those patients cope with problems related to debilitating chronic disease,” said Eduardo Bruera, M.D., a professor in and chair of the Department of Palliative Care and Rehabilitation Medicine at The University of Texas MD Anderson Cancer Center.

Benefits of palliative care

For cancer patients, the most noticeable benefit of palliative care (also called supportive care) is the relief of physical symptoms such as pain, fatigue, lack of appetite, nausea and vomiting, or shortness of breath. “We have demonstrated consistently that when people are seen by the supportive care team in addition to their oncologist, they feel better,” Dr. Bruera said.

But palliative care is not limited to pain management; it includes counseling and other services that can ease the emotional and spiritual distress of patients and their families.

Palliative care may also offer a financial benefit to patients and their families. Dr. Bruera said that patients who receive palliative care concurrently with cancer treatment and continue to do so after treatment options have been exhausted are less likely than those not receiving palliative care to be given a costly and unnecessary escalation of care in emergency rooms or intensive care units at the end of life.

“Ours is a program in which patients’ overall physical and emotional care is integrated with their cancer treatment.”
— Dr. Eduardo Bruera

These benefits, plus a survival benefit, were documented in a 2010 study reported in the New England Journal of Medicine. In the study, patients with metastatic non–small cell lung cancer who received palliative care had better quality of life, were less likely to receive aggressive care at the end of life, and had a longer median survival duration than those who did not receive palliative care.

Similar studies to determine whether palliative care will lengthen survival for patients with other types of cancer are under way at MD Anderson and other centers, and Dr. Bruera said preliminary data from these studies are promising. He hypothesized that the survival benefits from palliative care likely result from a combination of factors. “If patients feel better emotionally and physically, they are able to continue their cancer treatment,” Dr. Bruera said. “Another point that has been shown very clearly for other diseases is that untreated physical and emotional distress can shorten lives. If a patient has untreated pain, fatigue, depression, and nausea, there is a chance that he or she will die of complications from that continued stress.”

For these reasons, Dr. Bruera encourages oncologists to refer patients to a palliative care center at the first sign of physical or emotional distress.

To read more:

http://www2.mdanderson.org/depts/oncolog/articles/12/2-feb/2-12-2.html

DX IDC TNBC 6/09 age 49, Stage 1,Grade 3, 1.5cm,0/5Nodes,KI-67 48%,BRCA-,6/09bi-mx, recon, T/C X4(9/09)
11/10 Recur IM node, Gem,Carb,Iniparib 12/10,MRI NED 2/11,IMRT Radsx40,CT NED11/13,MRI NED3/15

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SagePatientAdvocates View Drop Down
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Post Options Post Options   Thanks (0) Thanks(0)   Quote SagePatientAdvocates Quote  Post ReplyReply Direct Link To This Post Posted: Feb 28 2012 at 6:34pm
This is an excellent article, Donna. Thank you so much for posting it!!!!

A few months ago I went to a palliative care conference at MD Anderson and it was very well done.

Dr. Bruera spoke several times and he was absolutely excellent.

In the article above Dr. Bruera stated that it is important for oncologists to refer patients to the palliative care department at the first sign of physical or emotional distress.

And therein, from my experience, lies the major problem. The oncologists, all to often, never refer their patients to supportive palliative care services and also rarely refer them to hospice. I am not sure what the reason is, but some possibilities might be-

-they don’t want to give up total control of the patient
-they feel the patient will think that the oncologist is ‘giving up on them’
-the patient does not want palliative care services because it had not been explained to the patient, properly, that you cne receive palliative care services even during treatment.
-the doctor is not associated with a hospital that has a good palliative care program
-they feel they can do it better than the palliative care team

whatever the reason/s....the patient, in my opinion, is shortchanged by the lack of a referral.

thanks again, Donna.

warmly,

Steve


Edited by steve - Oct 09 2012 at 6:38am
I am a BRCA1+ grandson, son and father of women affected by breast/oc-my daughter inherited mutation from me, and at 36, was dx 2004 TNBC I am a volunteer patient advocate with SAGE Patient Advocates
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Post Options Post Options   Thanks (0) Thanks(0)   Quote tnbcsucks Quote  Post ReplyReply Direct Link To This Post Posted: Feb 29 2012 at 9:44am
Hi!  That is a great article and so true! 
 
Steve the things you mentioned are dead on as well.  I work with Hospice as a volunteer manager.  We see it all.  We have oncologists who we get a little frustrated with at times.  They seem to have the idea that they are there to fix it...which is great, but there comes a time when things can't be fixed and the time for hospice service is vital. 
 
We will get the last minute call for a patient who was recieving chemo yesterday, but just can't do it anymore, they are in a crisis situation and usually will pass within a few days.  It unfortunately is not much time for us to go in and offer the family the things that we can do for them.  As you said, they get "short changed"  The oncologists as well as other doctors are just reluctant to give that refferal for whatever reason.
 
We work very hard on educating our doctors on end of life care.
 
My comment to everyone is...if the doctor doesn't do it, then a family member or a friend can ask for the referral to your local hospice or pallitative care center.  Ultimately a doctor has to sign the referral.  But if the family wishes to have a hospice/pall.care consult then they have that right. 
 
We have found it also seems to be a little easier if the family brings it up to the physician, then the physician doesn't feel like they are giving up on the patient.
 
Hospice would like to be able to have a patient on for at least a month so they can offer  the best end of life care to the family.  They are there to help the patient with pain control, as well as the family with preparing for the death and what is to come after.  There is a great team of people who try to help lessen the burden at the end of life.
 
So Don't be afraid to ask for the refferal yourself!!  You have that choice for a Hospice consult, it doesn't mean you have to go onto hospice or to a pall. care center, it just makes the family more educated with your options and you will then know when the right time might be in the future to elect hospice/pall. care services!
TNBC DX April, 2010,Lumpectomy May 3.5cm with clear nodes,Stage 2, Grade III Started Chemo on June 7: 4 A/C every other week and then 12 weeks of Taxol. followed by 6 weeks of radiation.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote suec Quote  Post ReplyReply Direct Link To This Post Posted: Apr 03 2012 at 11:57am
of course, just after i post, here is this great article.  thanks.  i feel so lucky to have all my oncs (met with two at mayo in last three yrs plus two at regular office and one at tiny hometown in texas for infusions)contacts be resourceful, generous, and fearless in my treatment.  suec
tnbc 3b: partial mas 5/06; 6 rounds FEC; 36 rad; 05/09-mets to bone; xeloda, avastin, zometa; gemzar & avastin; rads to hips; 8 mo on methotrexate+5fu; 5/11 mets to liver/lung; halevan fails;carb&Abrx
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Post Options Post Options   Thanks (0) Thanks(0)   Quote TNBC_in_NS Quote  Post ReplyReply Direct Link To This Post Posted: Apr 03 2012 at 10:19pm
Just read your post Sue and so glad to hear from you! Do drop in to let us know how your journey is going.  We are here for you too! Hugs, Helen in NS
Diag@57TNBC04/092.5cm Lquad 05/09 TCx4Radsx30CT03/01/10 FU03/31/10ClearBRCA- 01/2011 RTNBC BMX 06/14/2011~2013 clear
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Cochise Quote  Post ReplyReply Direct Link To This Post Posted: Apr 17 2012 at 4:50am

Definitely a great post Donna. Hats off to you! The Article that you have provided is very helpful.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote rmichaels Quote  Post ReplyReply Direct Link To This Post Posted: Oct 09 2012 at 2:10am
Thanks for this!!!  ;) Rach
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