Integrating palliative care early in the course of cancer therapy for patients with advanced acute myeloid leukemia (AML) resulted in substantial improvements in patients’ quality of life, mood and end-of-life care, a team of investigators has found.
The study, co-led at Duke University School of Medicine and Massachusetts General Hospital (MGH) Cancer Center, demonstrates the benefits of early integration of palliative care for symptoms and stress into oncology care for patients with high-risk AML, a highly aggressive cancer of the blood and bone marrow.
Thomas W. LeBlanc, M.D.“This is the first multi-site randomized trial of an integrated palliative care intervention in patients with any blood cancer,” said Thomas W. LeBlanc, M.D., a medical oncologist and palliative care physician at Duke Cancer Institute and co-lead author of a study appearing online Dec. 17 in JAMA Oncology.
Palliative care, which aims to prevent and relieve suffering by addressing physical, psychosocial and spiritual concerns, has been shown to improve quality of life and reduce psychological stress for patients who undergo bone marrow transplants to treat blood cancers, but it has not been widely used for patients with AML.
In the trial, 160 adults being treated for advanced AML at the four comprehensive cancer centers for advanced AML were randomly assigned to the intervention or to usual care.
Patients assigned to the integrated palliative and oncology care (IPC) intervention met with palliative care specialists who focused on establishing a relationship with each patient, assessing their needs, treating their symptoms, understanding their goals and expectations for treatment, and helping make decisions about their therapy.
Patients assigned to usual care received supportive measures from their oncology team and were permitted to receive palliative care if they or their oncologist requested it. Only six of the 74 patients assigned to usual care received palliative care early in the course of their illness.
Patients who received IPC reported significantly better quality of life and lower levels of depression, anxiety and PTSD at two weeks, and the benefits of palliative care on all these measures continued through 24 weeks.
Of the patients who died, significantly more who had been assigned to IPC had discussed end-of-life care preferences with their clinicians, and significantly fewer underwent chemotherapy in the last few weeks of life. Chemotherapy at the end of life is not curative and is associated with significant side effects that can severely impair quality of life.
“Oncologists rarely consult palliative care for patients with AML, in part due to the lack of evidence for the role of early palliative care in this population,” LeBlanc said. “Our study clearly demonstrates the benefits of this type of care for these patients.”
In addition to LeBlanc, study authors include Areej El-Jawahri, Alison Kavanaugh, Jason A. Webb, Vicki Jackson, Toby Campbell, Nina O’Connor, Selina Luger, Ellin Gafford, Jillian Gustin, Bhavana Bhatnagar, Alison Walker, Amir Fathi, Andrew Brunner, Gabriela Hobbs, Hilena Addis, Dagny Vaughn, Nora Horick, Joseph A Greer and Jennifer S. Temel.
This work was funded, in part, by a Sojourns Scholars Leadership Program grant from the Cambia Health Foundation.
Article first published in Duke Health News