|CANCER & TREATMENTS FOR CANCER CENTER PATIENTS PREVENTION & RISK ASSESSMENT CLINICAL TRIALS & RESEARCH LIVING WITH CANCER|
Means for a Better End:
Research shows supportive care may extend and improve life for people with advanced cancerSusan Urba, M.D., knows palliative care has a major image problem. As a medical oncologist, she knows that giving care to relieve symptoms, even if it does not cure the underlying disease, can have a tremendous benefit on quality of life. But many people look at it as a sign of surrender. They even worry that taking medications to control pain could actually hasten death.
And for patients experiencing debilitating side effects from treatments aimed to cure cancer, palliative -- or supportive -- care can help.
"The term 'palliativecare' is somewhat misunderstood," said Urba, medical director of the University of Michigan Comprehensive Cancer Center's Symptom Management & Supportive Care Clinic. "People associate it with giving up on treatment, when in fact its focus is on helping patients live more fully. Our goal is to help alleviate the symptoms and side effects that interfere with the things that people value most, like spending quality time with family."
In fact, new research suggests palliative care may actually extend life. Earlier this year, a study in The New England Journal of Medicine showed that patients with metastatic non-small-cell lung cancer survived longer if they had palliative care soon after diagnosis, even though many of them decided not to pursue aggressive treatment as their lives were ending.
What's more, patients who received palliative care reported lower rates of depression and higher quality of life. On average, they lived 2.7 months longer than those who received standard treatment without supportive care.
In an even larger study three years ago, an analysis of the medical records of 4,493 Medicare patients showed that hospice patients survived 29 days longer than those receiving standard care. Survival rates were significantly longer for those with lung and pancreatic cancer, according to the study, which was published in The Journal of Pain and Symptom Management.
One of the key components of supportive care is giving patients time to talk about how they want to live, Urba said. Because of advances in cancer treatment, patients have more options for care. But it can be difficult to know which choices will be right for an individual patient.
That's why it's important for patients to talk through what matters most to them and what the goals of treatment are. If the cancer is very advanced, is the hope of an extra week or two of life worth the often severe side effects that accompany aggressive chemotherapy? How would a patient prefer to spend the last days of his or her life? At what point is it time to stop trying chemotherapy for an advanced-stage cancer and focus on making the most of whatever time is left?
These conversations typically take place between the patient, family and oncologist. But occasionally a team member from the Supportive Care Clinic can be helpful by clarifying what kind of care can be delivered in the palliative setting.
This article first appeared in the Fall, 2010 issue of Thrive.