LISBON, Portugal — Palliative care is often underused in cancer care, but a simple name change can dramatically alter that and yield positive and productive results, said Matti S. Aapro, MD, Genolier Cancer Center, Genolier, Switzerland, speaking here at the Advanced Breast Cancer Fifth International Consensus Conference (ABC5).
“Palliative care should be called ‘supportive treatment’ — it’s not just about the end of life,” said Aapro, who discussed reasons for the change and then presented data from a 2009 study that showed dramatic effects at a major US cancer center.
He explained that both palliative and supportive care are integral to patient care, but palliation has an image problem: it is often misperceived as the end of the line for patients and their care team — the time where they will part company as patients discontinue active treatment and enter hospice.
In reality, palliative care, which primarily aims to provide relief from pain and other distressing symptoms, can be offered to all patients with cancer, regardless of their stage, and can greatly improve quality of life, he said.
Supportive care, on the other hand, is typically thought of as involving treatment management and posttreatment issues, Aapro also explained.
Traditionally speaking, supportive care alleviates symptoms and complications of cancer; reduces or prevents treatment toxicities; supports communication with patients about their disease and prognosis; and eases patients and their caregivers’ emotional burdens, per the Multinational Association for Supportive Care in Cancer.
By contrast, Aapro said a newly branded supportive care — one that incorporates the traditional notions about palliative care — breaks down that sequential timing and should proactively be offered to patients. “It should be there at the beginning, when they start treatment,” he said.
Dramatic Results With Experiment in Texas
Rather than take on the daunting task of educating physicians and patients about the true meaning of palliative care, one well-known institution wondered what would happen if it simply substituted the word “supportive,” said Aapro.
“The results were remarkable,” he commented.
As of 2009, palliative care referrals at MD Anderson Cancer Center in Houston, Texas, typically happened late in the course of a patient’s illness.
Theorizing that prevailing negative assumptions about palliative care posed an obstacle to early patient referral, MD Anderson investigators, led by Nada Fadul, MD, conducted a survey among a random sample of 100 midlevel providers and 100 medical oncologists. A total of 140 (70%) of 200 participants responded (74 midlevel providers and 66 medical oncologists).
More participants preferred the name “supportive care” (80% midlevel providers, 57% medical oncologists) compared with palliative care (27% midlevel providers, 19% medical oncologists; P < .0001).
When the investigators combined data from the two groups of professionals, they found that the combined group stated a significantly increased likelihood to refer patients on active primary ([vs not to] — 79% vs 45%, P < .0001) and advanced cancer (89% vs 69%, P < .0001) treatments to a service named “supportive care.” Medical oncologists and midlevel providers heavily preferred the name supportive care and stated more likelihood to refer patients on active primary and advanced cancer treatments to a service named “supportive care.”
As a follow-up to this study, the team changed the name of the unit and showed dramatic results.
In a study of records of 4701 consecutive patients with a first palliative care consultation before and after the name change, they found a 41% greater number of palliative care consultations (1950 vs 2751 patients; P < .001), mainly as a result of a rise in inpatient referrals (733 vs 1451 patients; P < .001). And in the outpatient setting, they found a shorter duration from hospital registration to palliative care consultation (median, 9.2 months vs 13.2 months; P < .001) and from advanced cancer diagnosis to palliative care consultation (5.2 months vs 6.9 months; P < .001). They also found a longer overall survival duration from palliative care consultation (median 6.2 months vs 4.7 months; P < .001).
Beyond the name change, is there anything else clinicians can do to facilitate earlier palliative care referrals?
“There a lot [of additional options], some of which may require some reorganization,” Aapro told Medscape Medical News.
He cited a number of situations for advanced breast cancer. “For example, integrating the primary care team if advanced breast cancer tumor boards exist, which is often not the case.” Aapro also said that it is helpful when oncologists see patients along with their primary care team early rather than “when things are dire.”
Advanced Breast Cancer Fifth International Consensus Conference (ABC5): Presented November 14, 2019.