Ambassador Blog Series: Leah Marcotte of U of Washington shares her thoughts on an important trial in Palliative Care

December 10, 2014

Leah Marcotte Washington

Name: Leah Marcotte, PGY1
Institution: University of Washington
Leah is a first year resident in Internal Medicine, Primary Care at the University of Washington. She finished medical school last May at the University of Pennsylvania. Her interests include primary care, health policy and health IT.

Trial: Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer.
Authors: Temel et al.
Journal: New England Journal of Medicine
Date: August 2010

The trial is important because:

1) This is the landmark study in palliative care. That there is a landmark study in palliative care is hugely important to the field and I think to patient care moving forward.

2) Results were actually better than the authors anticipated – adding palliative care to terminal cancer treatment had a mortality benefit.

3) Especially in trials focusing on end-of-life care, meaningful benefit to patients is often difficult to determine, but is ultimately what you want to know to help inform discussions and decision making with patients. In this study, the authors used patient-reported data, which is valuable in ascertaining perceived benefit to patients. They reported results that demonstrated not only statistical but clinical significance.

My Key Takeaways:

1) Palliative care works – in this study, patients were happier, hospice was utilized earlier and patients lived longer.

2) Palliative care and hospice care are not synonymous. Patients can receive aggressive care alongside palliative care, but palliative care helps to manage symptoms and aids in discussion of goals of care where medicine has traditionally fallen short.

Potential shortcomings:

The study’s patients were a relatively homogenous group  – not very diverse, with the same diagnosis and similar functional status. Future studies that look at more diverse populations and different diagnoses will allow for stratification of data which may help us to provide better patient-centered care

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