Open AccessEffects of Early Integrated Palliative Care on Caregivers of Patients with Lung and Gastrointestinal Cancer: A Randomized Clinical Trial
Author(s) -
ElJawahri Areej,
Greer Joseph A.,
Pirl William F.,
Park Elyse R.,
Jackson Vicki A.,
Back Anthony L.,
Kamdar Mihir,
Jacobsen Juliet,
Chittenden Eva H.,
Rinaldi Simone P.,
Gallagher Emily R.,
Eusebio Justin R.,
Fishman Sarah,
VanDusen Harry,
Li Zhigang,
Muzikansky Alona,
Temel Jennifer S.
Publication year - 2017
Publication title -
the oncologist
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.176
H-Index - 164
eISSN - 1549-490X
pISSN - 1083-7159
DOI - 10.1634/theoncologist.2017-0227
Subject(s) - medicine , hospital anxiety and depression scale , palliative care , randomized controlled trial , quality of life (healthcare) , anxiety , mood , depression (economics) , distress , family caregivers , intervention (counseling) , lung cancer , confidence interval , cancer , physical therapy , psychiatry , nursing , clinical psychology , macroeconomics , economics
Background The family and friends (caregivers) of patients with advanced cancer often experience tremendous distress. Although early integrated palliative care (PC) has been shown to improve patient‐reported quality of life (QOL) and mood, its effects on caregivers’ outcomes is currently unknown. Materials and Methods We conducted a randomized trial of early PC integrated with oncology care versus oncology care alone for patients who were newly diagnosed with incurable lung and noncolorectal gastrointestinal cancers and their caregivers. The early PC intervention focused on addressing the needs of both patients and their caregivers. Eligible caregivers were family or friends who would likely accompany patients to clinic visits. The intervention entailed at least monthly patient visits with PC from the time of diagnosis. Caregivers were encouraged, but not required, to attend the palliative care visits. We used the Hospital Anxiety and Depression Scale (HADS) and Medical Health Outcomes Survey Short‐Form to assess caregiver mood and QOL. Results Two hundred seventy‐five caregivers (intervention n = 137; control n = 138) of the 350 patients participated. The intervention led to improvement in caregivers’ total distress (HADS‐total adjusted mean difference = −1.45, 95% confidence interval [CI] −2.76 to −0.15, p = .029), depression subscale (HADS‐depression adjusted mean difference = −0.71, 95% CI −1.38 to −0.05, p = .036), but not anxiety subscale or QOL at week 12. There were no differences in caregivers’ outcomes at week 24. A terminal decline analysis showed significant intervention effects on caregivers’ total distress (HADS‐total), with effects on both the anxiety and depression subscales at 3 and 6 months before patient death. Conclusion Early involvement of PC for patients with newly diagnosed lung and gastrointestinal cancers leads to improvement in caregivers’ psychological symptoms. This work demonstrates that the benefits of early, integrated PC models in oncology care extend beyond patient outcomes and positively impact the experience of caregivers. Implications for Practice Early involvement of palliative care for patients with newly diagnosed lung and gastrointestinal cancers leads to improvement in caregivers’ psychological symptoms. The findings of this trial demonstrate that the benefits of the early, integrated palliative care model in oncology care extend beyond patient outcomes and positively impact the experience of caregivers. These findings contribute novel data to the growing evidence base supporting the benefits of integrating palliative care earlier in the course of disease for patients with advanced cancer and their caregivers.