Specialty palliative care can improve quality of life for patients with advanced cancers by providing emotional and psychological support and managing physical symptoms that aren’t addressed through standard oncology treatments.
But that care isn’t accessible to everyone who needs it — and a new University of Pittsburgh trial confirms that fixing that disparity may be tougher than expected, while providing important clues for next steps.
“We know that palliative care can improve quality of life for patients with serious diseases, and that’s really exciting,” said Dr. Yael Schenker, a professor of medicine and the director of the Palliative Research Center at Pitt. “But the vast majority of people with advanced cancer don’t have access to this support because there is a shortage of specialty palliative care clinicians.”
Palliative care specialists also tend to be concentrated in academic research centers and national cancer institutes, so their services are less accessible at community and rural oncology practices where most cancer patients receive their treatments.
With the goal of developing a low-cost and widely available model of palliative care, Schenker and her team worked with UPMC Hillman Cancer Center to train oncology infusion nurses to provide this care in addition to their usual duties of administering chemotherapy, blood products and other treatments.
“We chose infusion nurses because they are in every oncology practice, and they have existing relationships with patients and oncologists,” said Schenker. “We wanted to leverage those relationships and the strength of existing oncology teams.”
To investigate whether palliative care led by infusion nurses would improve patient well-being, the researchers set up a clinical trial with 672 advanced-stage cancer patients who were being treated at 17 of the nearly 70 Hillman Cancer Center oncology practices located in communities of western Pennsylvania. Half of the patients received standard oncology care, and the other half received up to three palliative care sessions in addition to standard treatments.
During monthly palliative care sessions, nurses focused on symptom assessment, emotional support, coordination of care and planning for future care.
After three months, the researchers found that both patient groups had similar scores for quality of life, physical symptoms, anxiety and depression, an unexpected finding that they report today in JAMA Internal Medicine.
According to Schenker, one possible reason that they didn’t see improved well-being in the palliative care group is that the nurses’ other tasks made it difficult to provide this additional care.
“The commitment and enthusiasm with which these nurses threw themselves into this role was really amazing. Many of them told us it was meaningful for them,” said Schenker. “But they also told us it was a very different skill set from their day-to-day roles as infusion room nurses, so asking these nurses to juggle these different tasks may have created a bit of a disconnect.”
The researchers suggest that allotting more time for palliative care sessions or allocating separate days for different types of care could be better approaches in the future.
Another unexpected challenge, Schenker said, was delivering the full three sessions to patients.
“This trial was done at Hillman community sites, not at the larger academic centers that are more used to doing research. We asked these clinics to do something extra, and sometimes they were understaffed or there was an administrative turnover or other real-world issues came up that made this challenging,” Schenker explained.
For participants in the palliative care group, higher session attendance was linked with reduced physical symptoms, such as pain, fatigue and nausea, suggesting that more sessions over a longer period may be needed to see improvements in well-being.
The findings from this study will help guide future research efforts to figure out the best ways to offer palliative care to a wide range of people.
“Another area that we are really excited about is tele-palliative care such as video visits or smartphone apps,” Schenker said. “We are working to leverage technology to maximize the reach of palliative care specialists in ways that are also more convenient for patients and families.”