Experimental Therapy, End-of-Life Care Can Coexist

Survey finds quality of life goes up with both

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HealthDay Reporter

TUESDAY, May 21, 2002 (HealthDayNews) -- In a strike against conventional wisdom, a new study suggests gravely ill cancer patients having experimental treatments should still receive end-of-life care to reduce suffering and prepare them and their families for death.

Researchers at the University of California at Davis found that so-called palliative therapy boosts the well-being of cancer patients during tests of new medications. The tests, known as clinical trials, were not disrupted.

"In the past, it's been an either-or situation: Seriously ill patients have been told they can have a clinical trial or they can go home and focus on quality of life," study co-author Frederick J. Meyers, professor and chair of internal medicine, says in a statement. "In our opinion, that's not an acceptable choice. Why can't patients have both?"

Doctors have long treated terminally ill cancer patients in clinical trials differently than those who have abandoned chemotherapy and radiation because it's too late, says Dr. David Spiegel, a professor of psychiatry and behavioral sciences at Stanford University who works with cancer patients.

Since the purpose of clinical trials is to help people live longer, doctors think they need a different approach than palliative care -- reduction of pain and psychological support -- which only comes after "they've given up," he says.

According to Spiegel, doctors change their emphasis for those undergoing experimental treatment, saying: "We'll postpone dealing with the end-of-life issues, we won't talk about the fact that you may die, we won't talk a lot about pain control, we'll focus on this new round of chemotherapy."

The researchers examined two groups of terminally ill patients who were taking part in clinical trials. All faced a prognosis of less than a year to live.

One group of 20 patients received experimental chemotherapy only. Another 44 patients got regular home visits from nurses and social workers who went with them to appointments for chemotherapy. The nurses and social workers provided advice and support regarding how to manage symptoms, handle emotions and deal with the prospect of death.

After seven months, the chemotherapy patients who received end-of-life care reported a higher quality of life than those who didn't. Those patients were also more likely to finish their chemotherapy treatments and get referrals to hospice care.

Meyers was to report his findings today at the American Society of Clinical Oncology annual meeting in Orlando, Fla.

Spiegel says the study results are encouraging and could convince doctors to not offer patients "painful choices that don't have to be made."

Decades ago, the adage of medical professionals was "cure rarely, relieve suffering often, and comfort always," he says. "In the 20th century, we rewrote the job description to cure always, relieve suffering if you have the time and let someone else comfort."

What To Do: Learn more about end-of-life care by visiting the National Hospice & Palliative Care Organization. For more information on end-of-life issues, visit Massachusetts General Hospital's Palliative Care Service.

SOURCES: David Spiegel, M.D., professor, psychiatry and behavioral sciences, Stanford University School of Medicine, Palo Alto, Calif.; May 21, 2002, presentation, American Society of Clinical Oncology annual meeting, Orlando, Fla.; University of California, Davis, press release

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