When Amy Berman, now 59, was diagnosed with stage IV inflammatory breast cancer in October 2010, she knew her disease had a poor prognosis. Inflammatory breast cancer is rare—representing just 1 to 5 percent of all breast cancer cases in the U.S.—and aggressive.
“My goal was to try and live the best possible life for as long as possible,” says Berman. One of Berman’s main goals was to continue working in her job as a senior program officer for the John A. Hartford Foundation in New York City, a nonprofit organization that focuses on improving the health and well-being of older adults. Almost immediately, she and her physician arranged for outpatient palliative care.
Palliative care is specialty care given to improve the lives of patients with serious or life-threatening illnesses by providing symptom management, advance care planning help, and psychological, emotional and spiritual care. Unlike hospice care, which is reserved for the end of life, palliative care can be given at any stage of an illness to support a patient.
Berman credits palliative care with allowing her to continue to do her work and travel with minimal discomfort and little downtime. A review of randomized controlled trials published Sept. 28 in Annals of Behavioral Medicine indicates that she is not alone in her positive experience. According to the study, outpatient palliative care is associated both with longer life and better quality of life for patients with advanced cancer.
Three high-quality trials, including a total of 646 patients, had data on survival at one year. In these trials, 56 percent of individuals with advanced cancer who received outpatient palliative care soon after their diagnosis were alive one year into the trials, compared with 42 percent of those patients who did not receive prompt palliative care—an absolute increase in survival of 14 percent. In five high-quality trials including 1,398 patients, the patients receiving palliative care also reported better quality of life.
“I was surprised by how consistent the results were across each of the studies we examined. It’s rare to see that,” says Michael P. Hoerger, a clinical health psychologist at the Tulane Cancer Center in New Orleans and lead author of the new analysis. “Fourteen percent is not huge, but if the best available medical evidence suggested palliative care might help people to live a little longer, most people would take that. I would.”
Many hospitals still do not have palliative care programs, especially in small towns and rural areas, says Hoerger. He says he hopes the study will lead hospitals to develop palliative care programs or expand existing ones.
“People feel if you’re opting for palliative care, you’re giving up, and that’s not the case,” says Katherine Sharpe, senior vice president of patient and caregiver support at the American Cancer Society in Atlanta. “When you get palliative care from the start, patients report less depression and they have less pain, less nausea and better mobility.”
Depression shortens life, says Sharpe, who was not involved in the research. From a financial standpoint, outpatient palliative care can also cut down on patient health care costs and help hospital systems, because it reduces emergency room visits and use of space in the intensive care unit, she says.
Eduardo Bruera, chair of the Department of Palliative, Rehabilitation and Integrative Medicine at the University of Texas MD Anderson Cancer Center in Houston, says that outpatient palliative care programs should be fully integrated with a patient’s cancer treatment beginning at diagnosis. “When the oncology team and the palliative care team works side-by-side from the outset, there’s not going to be tough handoff situations that normally can occur.” Bruera was also not involved in the research.
One limitation of the review is that the studies mainly included patients who were white and in their 60s and 70s, Hoerger points out. However, he says he suspects that studies including younger patients and patients from diverse cultural and economic groups would show similar results—or indicate that these patients could benefit even more from palliative care.
“For whatever reason, younger patients and culturally diverse patient populations tend to receive more aggressive treatment, which leads to more side effects,” Hoerger says. “Palliative care could be more helpful for these groups.”
Eight years after her diagnosis, Berman continues to call on the expertise of her palliative care team. When she recently experienced painful bone metastases between her ribs, they figured out the best way to get her out of pain quickly. Based on the team’s research, Berman opted to get one large dose of radiation instead of 10 to 20 rounds and was able to fly across the country for work. The team also prescribed medication that Berman could use in case the pain returned while she was away.
“It’s pretty amazing. My team keeps me out of harm’s way. Outpatient palliative care is the best friend of the seriously ill,” she says.
October 25, 2018