Huge Progress in Palliative Care

A Q&A with Diane E. Meier, MD, FACP, Director, Center to Advance Palliative Care; Professor of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai; New York, NY;

Originally published November 8, 2017

Q: You wrote in MedGenMed in 2007 that palliative care was the job of all hospitals. In October 2017 you were honored at the National Academy of Medicine for your achievements in this field. How fully has your charge to hospitals in 2007 been realized?

A: Palliative care is a fairly new medical specialty devoted to reducing suffering and improving quality of life for people living with serious illness-whether the disease is curable, chronic, or life threatening and progressive. Palliative care teams work alongside disease treatment specialists to provide an added layer of support in service of pain and symptom management, family support, attention to the social determinants of health, and skilled communication about what to expect and what matters most to the patient in the context of the reality of the illness. Multiple studies demonstrate palliative care’s contribution to achievement of the triple aim: better experience of care, better care outcomes (including survival in several studies), and as an epiphenomenon of better care, much lower unnecessary utilization of 911 calls, ED visits, and hospitalization. Continue reading…

Brain Cancer Like McCain’s Has Hundreds Of Experimental Therapies (With Little Success)


“The type of brain cancer John McCain was diagnosed with July 14, glioblastoma, is among the most difficult cancers to beat. The reasons it’s so hard to treat, as I discussed previously, include its location, its genetic diversity within and across patients, and its aggressiveness. Glioblastoma (GBM) is also among the most devastating cancers in its effects since it attacks the brain, the control center for the body’s functions and the essence of an individual’s personality. Even people who survive rarely remain the same person after their treatment.”

Go to full article.

If you’re wondering whether this story applies to your own cancer case or a loved one’s, we invite you to use our ASK Cancer Commons service.

Radium-223 Benefits Survival, Not Just for Palliative Care

“Despite what many believe, not all radiopharmaceuticals are just for pain palliation, says Phillip J. Koo, MD, a radiologist of Memorial Hospital and University of Colorado Hospital.

“The ALSYMPCA trial, which was the basis for the 2013 FDA approval of radium-223 dichloride (Xofigo) showed a median overall survival (OS) of 14 months with radium-223 versus 11.2 months with placebo (HR, 0.70; P = .00185) in patients with metastatic castration-resistant prostate cancer (mCRPC).

“Despite the fact that it has been 3 years since the pivotal ALSYMPCA trial and the coinciding FDA approval, many oncologists still need to be educated regarding radium-223’s benefits, says Koo.”

Short-Course Palliative RT Cuts Cancer Pain

“Short-course palliative radiotherapy provided pain relief equivalent to that of conventional protocols, and allowed patients with advanced cancer to spend more time at home, investigators reported.

“Half as many patients underwent more than five treatment sessions and hospital length of stay decreased by 50% following implementation of a palliative radiation oncology service. At the same time, significantly more patients completed the planned course of radiotherapy, which resulted in a trend toward better pain relief.”

Doctors Often Overtreat with Radiation in Late-Stage Lung Cancer

“Almost half of patients with advanced lung cancer receive more than the recommended number of radiation treatments to reduce their pain, according to a new study published in the Journal of the National Cancer Institute.

“Radiation therapy that is palliative, or not intended to cure, can reduce the pain from  and improve quality of life. But unnecessary treatments add to costs and require needless trips to the hospital—and can lead to radiation toxicity and difficulty in swallowing.

“Guidelines developed from clinical trials recommend no more than 15 radiation treatments be given for pain in stage 4 . The guidelines recommend that patients not receive chemotherapy at the same time, to reduce the risk of toxicity.”

Important New Research on Early Palliative Care for Advanced Cancer Patients Published

“Researchers at Trinity College Dublin and Mount Sinai in New York have just published new research which for the first time provides strong evidence on the economic benefits of early palliative care intervention for people with an advanced cancer diagnosis. Their findings were published today in the highly esteemed international peer reviewed Journal of Clinical Oncology.

“Previous research has shown the clinical benefits of early palliative care, but this new study robustly demonstrated how early access to expert palliative care decision making resulted in very significant cost reductions of up to 24%. The intervention reduced both the length and intensity of hospital stay for patients with advanced cancer.

“The researchers from Trinity’s Centre for Health Policy and Management and Mount Sinai’s Icahn School of Medicine, led by Peter May, HRB Economics of Cancer Fellow at Trinity, studied over 1000 patients’ pathways of care in five major US hospitals and looked at costs associated with their care based on whether they saw a specialist palliative care consultation team or received standard hospital care.”

When Should Palliative Care Be Integrated into Cancer Care?

“Palliative care should be integrated into cancer care during any cancer stage and in patients at any age.

“Palliative care is commonly confused with end-of-life care, but it is initiated at the time of a cancer diagnosis to relieve suffering throughout the duration of the disease.

“In a 2010 study published in The New England Journal of Medicine, researchers found that the early initiation of palliative care among patients with advanced lung cancer was not only associated with improvements in quality of life for patients, but that palliative care also decreased the need for aggressive care at the end of life and even increased survival in some cases.

“Yet, according to a 2014 study published in Journal of Clinical Oncology, patients are not always referred to a palliative care team or they are referred late during the course of illness.  According to the paper, feasible service delivery models are lacking in both the inpatient and outpatient setting.”

Clinical Trial: Survival Increased with Early Start of Palliative Care

“In the ENABLE III study reported in the Journal of Clinical Oncology, Bakitas et al found that early vs delayed initiation of a palliative care intervention did not result in improved patient-reported outcomes or resource use. Early initiation was associated with better 1-year survival.

“In the trial, 207 patients with advanced cancer from the Norris Cotton Cancer Center, affiliated outreach clinics, and the VA Medical Center in New Hampshire and Vermont were randomly assigned between October 2010 and March 2013 to receive an in-person palliative care consultation, structured telehealth nurse coaching sessions (once per week for six sessions), and monthly follow-up either early after enrollment (n = 104) or 3 months later (n = 103). Outcomes were quality of life, symptom impact, mood, 1-year survival, and resource use (hospital/intensive care unit days, emergency room visits, chemotherapy in last 14 days, and death location). Quality of life was assessed by the Functional Assessment of Chronic Illness Therapy-Palliative Care scale and Treatment Outcome Index, symptom impact by the Quality of Life at End of Life symptom impact subscale, and mood by the Center for Epidemiologic Studies-Depression scale.

“The early and delayed groups did not significantly differ with regard to age, gender, marital status, race/ethnicity, religion, attendance of religious services, praying for own health, work status, medical insurance, ever smoked status, current smoking status, percent with caregiver enrolled in the study, rural residence, cancer diagnoses, disease status at enrollment, brain metastases, chemotherapy or radiotherapy at enrolment, Charlson comorbidity score, Karnofsky performance status, living will/durable power of attorney or do not resuscitate order, or referral to hospice. The early group had a higher education level (P  = .05), higher alcoholic beverage consumption per week (P = .04), and a greater proportion of patients enrolled in a clinical trial (18% vs 8%, P = .04). Among former smokers, there was a borderline significant trend (P  = .06) for history of fewer cigarettes per day in the delayed group.”

Palliative Medicine under the Microscope: Not Every Patient with Cancer Needs Palliative Care

“In this edition of HemOnc Today, we cover the important topic of palliative management.

“In particular, we review the Oncology Nursing Society’s (ONS) recently published position statement on this issue.

“Nurses are among the strongest and most effective patient advocates, and it is pleasing to see them take a strong position on this crucial issue.”