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Early integrated palliative care improves coping strategies for patients with incurable cancer

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December 13, 2017

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Patients with terminal cancer who underwent early integration of oncology and palliative care made greater use of approach-oriented coping strategies compared with those who received only standard cancer care, improving their quality of life and reducing depression, study data showed.

“Palliative care clinicians aim to relieve symptom burden and improve quality of life by providing specialized knowledge and skills; assessing and treating physical symptoms; ensuring psychosocial, spiritual and bereavement support; facilitating communication about illness and prognosis with patients; family caregivers, and clinicians; and coordinating services and resources,” Joseph A. Greer, PhD, clinical director of psychology and research scientist in the Center for Psychiatric Oncology & Behavioral Sciences at Massachusetts General Hospital, and colleagues wrote. “Although numerous trials have demonstrated many benefits of early integrated palliative care for patients with incurable cancer, the key mechanisms by which this intervention model leads to improvements in outcomes are not understood.”

The researchers performed a secondary analysis evaluating adults with newly diagnosed, incurable lung cancer or noncolorectal gastrointestinal cancer (n = 350). They assigned patients to either early integrated palliative care or standard oncological care alone. Participants completed surveys — including Functional Assessment of Cancer Therapy to assess quality of life, Patient Health Questionnaire­—9 to assess depression and Brief COPE to assess coping — at baseline and at 24 weeks. Greer and colleagues tested the effects of intervention on coping strategies using linear regression, and used mediation regression models with bias-corrected bootstrapping to evaluate whether coping improvements mediated the way early palliative care affected patient-reported outcomes.

Patients who received early integrated palliative care showed a significantly increased use of approach-oriented coping strategies from baseline to 24 weeks (B = 1.09; SE = 0.44; P = .01). They also demonstrated a slightly reduced use of avoidant strategies (B = –0.44; SE = 0.23), which was not significant.

The rising use of approach-oriented coping and falling use of avoidant coping appeared associated with higher quality of life at 24 weeks, as well as lower depression scores.

Positive changes in approach-oriented coping, but not avoidant coping significantly mediated the effects of early palliative care on quality of life (indirect effect, 1.27; 95% CI, 0.33-2.86) and depressive symptoms (indirect effect, –0.39; 95% CI, –0.87 to –0.08).

“The state of oncology care has seen tremendous advances in precision medicine and targeted therapies; however, patients’ supportive care needs have never been greater, and early integrated palliative care represents a novel, efficacious approach toward alleviating suffering and improving quality of life for those with advanced disease,” the researchers wrote. “As the first mediation analysis of the early integrated palliative care model to our knowledge, this study provides evidence suggesting that palliative care clinicians help improve quality of life and mood outcomes [among] patients with incurable cancer, in part, by enhancing effective coping processes.” – by Andy Polhamus

Disclosures: Greer reports research funding from Pfizer. Please see the full study for all other authors’ relevant financial disclosures.

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