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Amy Umble is health reporter for The Free Lance-Star

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When it comes to palliative care, earlier is better than later

Dr. Christopher Lillis

Dr. Patrick McManus said yesterday that he could imagine the excitement that would have been generated if a new lung-cancer drug promised to make patients more comfortable and extended their lives. Yet, when a recent clinical trial found that early referral to palliative care did exactly that, little was said about it.

Dr. Christopher Lillis agreed with McManus, adding, “Aspects of this trial were really eye-opening.”

The two Fredericksburg-area internists were among the featured speakers yesterday at Mary Washington Hospital at a lunchtime session on end-of-life care. Their message was that when doctors refer their seriously ill patients for hospice and palliative care earlier rather than later, “at Stage 2 rather than Stage 4,” it can improve, even extend, their lives.

The two talked about a study that appeared in August in the New England Journal of Medicine. The study compared 151 newly diagnosed, metastatic lung-cancer patients. Half were randomly assigned to receive standard cancer treatment, including radiation, surgery and chemotherapy. The other half received standard cancer care, but within eight weeks of diagnosis, they also received outpatient palliative care.

Dr. Patrick McManus is director of Mary Washington Hospice.

Lillis described palliative care as “comfort care.” It includes managing symptoms, social support and assistance with the decisions that patients face. Palliative care is usually delivered alongside aggressive medical care, Lillis added, while hospice care is not.

In the study, those who received both cancer care and palliative care did better: their quality of life was better, they were not as depressed, they chose to visit the emergency room less often, they chose to have fewer chemotherapy treatments, and they chose to enter hospice care earlier. Most surprisingly, Lillis said, they lived longer, about 2.7 months.  

“It’s very counter-intuitive,” he said.

Lillis and McManus said the challenge for supporters of palliative care and hospice care is to change the perception held by patients and their doctors.

“I think we need to shift the focus,” Lillis said. “Hospice is not the end-point. It’s not dumping your patients because you’ve given up on them. I like to think of hospice like I do of nutritionists for those with diabetes. It’s someone who can augment the care I’m providing.”

(The New England Journal of Medicine study is available here. Dr. Atul Gawande writes about the study in his latest piece for the New Yorker. It is available here.)

Permalink: http://news.fredericksburg.com/rapidassessment/2010/11/30/when-it-comes-to-palliative-care-earlier-beats-later/