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Early access to palliative care linked to better quality of life

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Patients with advanced cancer have a better quality of life in the weeks before they die if they receive palliative care early on, according to a new study.

Researchers at the University of Leeds found that a longer period of palliative care was associated with fewer emergency hospital admissions and fewer hospital deaths.

“Our study provides new evidence to support the early integration of palliative care for cancer patients”

Lucy Ziegler

The study, using data from 2,479 adults in Leeds who died from cancer between January 2010 and February 2012, is the first of its kind in the UK to involve a large population. It looked specifically at when patients accessed palliative care and how this timing affected their quality of life.

The researchers also discovered that patients who received palliative care early were more likely to have access to opioids for pain relief and less likely to be given aggressive anti-cancer treatments close to death.

They noted that, although hospital was sometimes the most appropriate place of death, the level of care and comfort was lower than that possible with palliative care, which aimed to manage pain and offer support at home, in a hospice or care home.

The research, published in journal BMJ Open, was funded by the independent regional charity Yorkshire Cancer Research.

Lead study author Dr Lucy Ziegler, a Yorkshire Cancer Research academic fellow, said: “Previous studies have shown that palliative care intervention is associated with an increased proportion of deaths at home and a reduction in emergency admissions

“However, no study has investigated when and for how long patients need access to this care in order to receive quality of life benefits,” she said.

Of the 2,479 patients included in the study, 64.5% were given palliative care support. It was more likely to be received by people who were younger, or female and those with upper gastrointestinal cancers.

On the other hand, those with lung cancer or cancers of the central nervous system were significantly less likely to be able to receive palliative care.

People who received palliative care more than two weeks before death were significantly more likely to die in a hospice rather than a hospital. When it was given more than four weeks before death, patients were less likely to be admitted to hospital as an emergency.

Around two thirds to three quarters of patients with advanced cancer experience moderate to severe pain before death. The researchers found that access to palliative care was associated with being twice as likely to have access to strong opioids for pain relief.

University of Leeds

Dying cancer patients receiving pain relief ‘too late’

Lucy Ziegler

Palliative care initiated more than 32 weeks before death was associated with a reduction in chemotherapy in the last four weeks of life.

“Our study provides new evidence to support the early integration of palliative care for cancer patients,” said Dr Ziegler.

She has also been awarded funding from the National Institute for Health Research to improve communication between clinicians and patients with advanced cancer to help facilitate timely access to palliative care.

Meanwhile, Yorkshire Cancer Research recently announced a £1.3m palliative care improvement programme for the county.

It will investigate further how and when patients access palliative care in Yorkshire, introduce new measures to improve how symptoms are formally assessed and monitored, and equip clinical teams with resources and training to help them address those symptoms.

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