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Making the Case for Early Palliative Care

Throughout the United States, palliative care (PC) is becoming a more established and integral component of comprehensive cancer care for patients with advanced disease. “Published research has shown that PC is associated with better quality of life and mood, improved symptom control, and more appropriate health resource use,” explains Jennifer S. Temel, MD. “It has also been linked to increased patient and caregiver satisfaction, healthcare savings, and survival.” Clinical guidelines recommend that all patients with metastatic cancer be offered PC services early in the course of the disease. Currently, many cancer centers have some form of PC services, such as inpatient consultative services and acute inpatient units. PC clinics, on the other hand, are scarcer entities. Recent analyses have suggested that integrating PC early in the ambulatory care setting is feasible and can improve patient-reported outcomes as well as several key measures of quality end-of-life care and resource use. Early integration of PC with cancer care improves patients’ understanding of their disease and prognosis, leads to more timely transitions to hospice care, and decreases chemotherapy use near the end of life. Looking Closer at Early Palliative Care According to Dr. Temel, more information about the nature and elements of early PC in ambulatory care is needed. “The integration of PC with standard oncologic care may have a different emphasis and focus than traditional inpatient or consultative PC,” she says. Earlier and longer collaborative relationships between PC clinicians and patients may allow the time and opportunity to face complex issues like treatment decisions and advanced care planning rather than focus mostly on acute symptom management and imminent death. A study...

New Guidelines for Advanced NSCLC

In the most recent update, investigators conducted a literature search for all relevant randomized trials published since 2002, looking specifically for treatment strategies that improved overall survival. Drugs that were found to only improve progression-free survival were evaluated in light of their toxicity and quality-of-life benefits. Several new drugs have entered the market, so it was important to take a fresh look at our first- and second-line therapies. One of the most important additions to first-line treatment for stage IV NSCLC has been the arrival of bevacizumab, which can be used in conjunction with carboplatin-paclitaxel. There have also been new arrivals on the second-line therapy, including pemetrexed and erlotinib. In addition to existing therapies, these new drugs have been evaluated and ranked according to a number of treatment scenarios and the likely benefits that they can confer to patients. According to the evidence, these newer drugs appear to have made an impact on treatment decisions. Clinicians should recognize that it’s important to tailor treatments based on individual characteristics of patients. For example, physical age should no longer be factored into treatment decisions. Instead, patients’ physiological age and performance status are more appropriate benchmarks for deciding on treatments. Additionally, race and genetic makeup appear to impact treatment strategies.  Genes Matter A new aspect of the 2009 ASCO guideline update is the evaluation of genetic biomarkers, which may affect how patients will respond to a particular agent. While there are several biomarkers with evidence supporting an impact on disease progression, none are currently as well-characterized as mutations in the epidermal growth factor receptor (EGFR). When patients have known EGFR mutations, treatment...
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