Division of Hematology and Oncology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
Oncologist. 2017 Dec;22(12):1528-1534. doi: 10.1634/theoncologist.2017-0227. Epub 2017 Sep 11.
The family and friends (caregivers) of patients with advanced cancer often experience tremendous distress. Although early integrated palliative care (PC) has been shown to improve patient-reported quality of life (QOL) and mood, its effects on caregivers' outcomes is currently unknown.
We conducted a randomized trial of early PC integrated with oncology care versus oncology care alone for patients who were newly diagnosed with incurable lung and noncolorectal gastrointestinal cancers and their caregivers. The early PC intervention focused on addressing the needs of both patients and their caregivers. Eligible caregivers were family or friends who would likely accompany patients to clinic visits. The intervention entailed at least monthly patient visits with PC from the time of diagnosis. Caregivers were encouraged, but not required, to attend the palliative care visits. We used the Hospital Anxiety and Depression Scale (HADS) and Medical Health Outcomes Survey Short-Form to assess caregiver mood and QOL.
Two hundred seventy-five caregivers (intervention = 137; control = 138) of the 350 patients participated. The intervention led to improvement in caregivers' total distress (HADS-total adjusted mean difference = -1.45, 95% confidence interval [CI] -2.76 to -0.15, = .029), depression subscale (HADS-depression adjusted mean difference = -0.71, 95% CI -1.38 to -0.05, = .036), but not anxiety subscale or QOL at week 12. There were no differences in caregivers' outcomes at week 24. A terminal decline analysis showed significant intervention effects on caregivers' total distress (HADS-total), with effects on both the anxiety and depression subscales at 3 and 6 months before patient death.
Early involvement of PC for patients with newly diagnosed lung and gastrointestinal cancers leads to improvement in caregivers' psychological symptoms. This work demonstrates that the benefits of early, integrated PC models in oncology care extend beyond patient outcomes and positively impact the experience of caregivers.
Early involvement of palliative care for patients with newly diagnosed lung and gastrointestinal cancers leads to improvement in caregivers' psychological symptoms. The findings of this trial demonstrate that the benefits of the early, integrated palliative care model in oncology care extend beyond patient outcomes and positively impact the experience of caregivers. These findings contribute novel data to the growing evidence base supporting the benefits of integrating palliative care earlier in the course of disease for patients with advanced cancer and their caregivers.
晚期癌症患者的家属和朋友（照护者）通常会经历巨大的痛苦。尽管早期综合姑息治疗（PC）已被证明可以改善患者报告的生活质量（QOL）和情绪，但目前尚不清楚其对照护者结局的影响。
我们对新诊断为不可治愈的肺癌和非结直肠胃肠道癌症患者及其照护者进行了早期 PC 与单独肿瘤治疗的随机试验。早期 PC 干预侧重于满足患者及其照护者的需求。有资格的照护者是可能陪伴患者就诊的家属或朋友。该干预包括从诊断时起至少每月对患者进行一次 PC 就诊。鼓励但不要求照护者参加姑息治疗就诊。我们使用医院焦虑和抑郁量表（HADS）和医疗保健结果调查短表来评估照护者的情绪和 QOL。
350 名患者中有 275 名照护者（干预组 137 名；对照组 138 名）参与了研究。干预措施导致照护者的总困扰（HADS 总分）有所改善（调整后的平均差异为-1.45，95%置信区间[CI]为-2.76 至-0.15，=0.029），抑郁子量表（HADS 抑郁）也有所改善（调整后的平均差异为-0.71，95%CI 为-1.38 至-0.05，=0.036），但焦虑子量表或 12 周时的 QOL 没有差异。24 周时照护者的结局没有差异。在患者死亡前 3 个月和 6 个月的终末期下降分析中，照护者的总困扰（HADS 总分）显示出显著的干预效果，对焦虑和抑郁子量表也有影响。
对新诊断的肺癌和胃肠道癌症患者进行早期 PC 干预可改善照护者的心理症状。这项工作表明，早期综合 PC 模式在肿瘤治疗中的益处不仅限于患者的结局，还积极影响了照护者的体验。
对新诊断的肺癌和胃肠道癌症患者进行早期 PC 干预可改善照护者的心理症状。这项试验的结果表明，早期综合姑息治疗模式在肿瘤治疗中的益处不仅限于患者的结局，还积极影响了照护者的体验。这些发现为越来越多的支持晚期癌症患者及其照护者在疾病早期纳入姑息治疗的益处的证据提供了新的数据。
