An article and editorial in this week’s NEJM on the beneficial effect of early use of palliative supportive care on survival in metastatic lung cancer.
The editorial notes;
The specific components of the study’s palliative care intervention remain unspecified and hence may not be easily reproducible in other practice settings. For example, the salutary effect of additional time with and attention from health care providers and physicians, as opposed to a specific benefit derived from palliative care itself, was not assessed and is a limitation of the study. The reasons for the 2.7-month survival benefit in the palliative care group — a benefit that is equivalent to that achieved with a response to standard chemotherapy regimens — are unknown but may result from effective treatment of depression, improved management of symptoms, or a reduction in the need for hospitalization.
Medicynical note: A 2.7 month survival benefit is, as noted, equal or better to that achieved not only with standard chemotherapy but also to that (if any) attained with the newer super expensive targeted agents. For example with Avastin at nearly $100,000/year –“The median survival was 12.3 months in the group assigned to chemotherapy plus bevacizumab, as compared with 10.3 months in the chemotherapy-alone group (hazard ratio for death, 0.79; P=0.003).” –an improvement of just 2 months. (NEJM 2006;355:2542-2550)
This is however a small study and the results need confirmation, perhaps with more detail on the palliative interventions used. Cost would be of interest as well.
Medicynic 