Monday, 6 June 2016

Early Palliative Care: + Life Quality + Life Quantity

A meta-analysis (you can access it through the link provided by the tweet from Dr. Jordi Amblàs) of 30 studies in 5 different countries and with a participation of more than one million patients shows that patients who had received palliative care were accessing the emergency wards less in the last month of life, which is very positive, considering that many emergency practitioners confess they are not equipped to properly address this type of patients, and also a trip to an emergency service increases the risk that people in advanced stages of illness are subjected to disproportionate actuations. As for the transcendent matter of the moment of the introduction of palliative care, although there are indications that precocity is positive, this meta-analysis fails to reach conclusions due to the heterogeneity of the selected studies.

However, a much smaller study (JS Temel NEJM 2010, Greer JA JCO 2012), of Massachusetts General Hospital, where researchers worked with a group of 151 patients in the stage IV of lung cancer, does draw a conclusion. Half of the patients followed the usual cancer treatment and the other half had an additional intervention which simply consisted in scheduling visits to a specialist palliative care. The result was that the latter group was first to leave chemotherapy, start palliative treatment and suffered less in the final moment; and the surprise of this study, at least for me, is that it showed that those patients who had started the contact with the palliative care specialist first, lived 25% longer than the control group.

As Atul Gawande, author of Being mortal, says: "If the effect of finding a clear way of talking to the patients about how to deal with the last days of life and then begin mitigation practices in accordance with the contents of the conversation, was due to a new drug, the FDA should approve it with urgency". The lesson of this study continues Dr. Gawande, is almost zen: "people live longer only when they stop attempting to live longer".

Jordi Varela

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