What’s taking so long?F. Amos Bailey, MD Oct 15, 2019
Jennifer Temel’s article in the NEJM was published 9 years ago and has now been cited in over 5000 subsequent articles. Temel and colleagues reported the findings of their rather simply designed Randomized Control Trial (RCT) of palliative care for Stage IV Non-Small Cell Lung Cancer. 150 people referred were randomly assigned to a Palliative Care (PC) consult or could have a PRN referral if the patient/family or provider desired. The results clearly demonstrated that PC was associated with better physical symptom control, less psycho-social distress with better quality of life; less aggressive in the hospital EOL care but also an amazing 3-month improvement in SURVIVAL.
After this study was published, I went around with my chest puffed out. “PC is more effective than TARCEVA and much less expensive; all cancer patients should have PC!” Uptake was disappointingly not what any of us expected. Nine years later, articles are still being published about the benefits or early PC consultation but relatively few patients are receiving it.
Now in a recent JAMA Oncology article, Sullivan and colleagues report on the real-world effect of PC consults for lung cancer patients in the VA. Their findings reveal again that PC consults 1-12 months after diagnosis was associated with a significant survival advantage. So why is it taking so long for PC to be adopted? If PC were a medication, it could take 10-15 years for it to become the standard of care. While PC is not a medication that can be manufacture, you do need to find and train the workforce.
CUPallcare MSPC and certificate programs at the University of Colorado Anschutz Medical campus can help. In addition, the primary palliative care Coursera course “Palliative Care: It’s Not Just Hospice Anymore” is another educational program designed to support healthcare professionals, caregivers, patients and public alike in the basics of this specialized approach. Getting the word out about palliative care and educating as many people as possible to this much-needed intervention will get the right care to the right person at the right time.
Sullivan, Donald R., et al. “Association of early palliative care use with survival and place of death among patients with advanced lung cancer receiving care in the Veterans Health Administration.” JAMA oncology (2019).
Temel, Jennifer S., et al. “Early palliative care for patients with metastatic non–small-cell lung cancer.” New England Journal of Medicine 363.8 (2010): 733-742.