乌鸦传媒

CHICAGO -- Caregivers of cancer patients had significantly better quality of life and less depression when palliative care was initiated soon after cancer diagnosis, a randomized trial showed.

During the first 3 months of follow-up, caregivers of patients with early palliative care had significantly more vitality and better social functioning, as well as significantly fewer symptoms of depression (P=0.05 to P=0.02). The reduced level of depression persisted at 24 weeks, but not the other outcomes.

Though several studies have suggested that patients benefit from early introduction of palliative care, this study is the first to show benefits for family caregivers of patients with cancer, , said during a press briefing prior to the annual meeting.

"We can now say that the benefits of early palliative care extend beyond patient outcomes and positively impact family caregivers," said El-Jawahri, of Massachusetts General Hospital Cancer Center. "We're truly seeing the impact of integrating early palliative care for patients with newly diagnosed disease and their families. It seems that the improvement in family caregiver outcomes appears to be at least partially mediated by improvement in patient outcomes.

"This suggests that early palliative care creates a powerful positive feedback loop in families facing cancer," she added. "While patients receive a direct benefit from early palliative care, their caregivers experience a positive downstream effect, which may make it easier for them to care for their loved ones."

The findings represent a new twist on existing evidence that the care patients receive can affect the bereavement process and adjustment of the family members of patients with cancer, said , of Weill Cornell Medicine and New York Presbyterian Hospital.

"Several studies have demonstrated this, but this is among the few looking at outcomes of a palliative care intervention," Prigerson said in an email.

Family caregivers have a key role in the care of patients with cancer, but the burden of the disease-associated responsibilities can negatively affect caregivers' quality of life and mood, as demonstrated by multiple studies.

Early integration of palliative care with cancer care has been shown to improve quality of life and mood in patients with advanced cancers, but evidence of any benefits of palliation on caregiver outcomes has remained sparse. To address the issue El-Jawahri and colleagues performed a randomized trial, involving family caregivers of patients with newly diagnosed incurable lung and gastrointestinal cancers. Each patient identified a relative or friend as the primary caregiver.

Investigators randomized 275 patients to early initiation of palliative care along with cancer care or to cancer care only. The trial evaluated a patient-focused intervention that involved at least monthly patient visits with palliative care specialists, beginning at enrollment. Family caregivers were not required to attend the palliative care sessions but were evaluated at baseline and at 12 and 24 weeks by means of the SF-36 quality-of-life instrument and the Hospital Anxiety and Depression Scale (HADS).

The trial had two principal objectives: Evaluate the impact of early palliative care on patient outcomes and on the quality of life and level of depression among caregivers. El-Jawahri discussed the results for the second objective and said that patient-related outcomes will be reported at the ASCO meeting, which will be held here June 3-7.

The data showed that 74.7% of the palliative care visits addressed patient symptoms, followed by coping in 70.2%, rapport in 44.4%, and illness understanding in 38.4%. Symptoms addressed most often during the visits were pain (58.4%) and fatigue (52.1%). The coping topics addressed most often during the palliation sessions were redirecting hope (71.1%), coping counseling (67.0%), and behavioral coping (65.4%).

At the 12-week follow-up, family caregivers in the palliative care arm had a significantly higher mean score on the vitality (1.1 versus -3.2, P=0.05) and social functioning (-3.0 versus -3.8, P=0.02) subscales of the SF-36, as well as fewer depressive symptoms on the HADS (-0.45 versus 0.24, P=0.02). Nonsignificant differences favoring the palliative care arm were observed for subscales related to bodily pain and physical-role function.

At 24 weeks, only the difference in depressive symptoms remained significantly different in favor of the family caregivers whose patients were randomized to early palliative care (-0.37 versus 0.28, P=0.05).

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