Practice 7
Appropriate to offer palliative care early in the management of patients with symptomatic, metastatic breast cancer to improve symptom control and quality of life.
Context
Palliative care includes more than care for people who are dying or nearing the end of their life. It focuses on relieving symptoms and improving quality of life for patients with life-threatening illness. This includes not only helping to control physical symptoms such as pain, but also on emotional wellbeing, relationships with others and spiritual needs.
A proportion of women with early breast cancer will experience progression of their disease, while some women have metastatic (also known as secondary or advanced) disease at diagnosis. These women may live with metastatic breast cancer for a number of years, and receive treatment which, while no longer curative, is aimed at delaying the progression of the cancer, relieving cancer-related symptoms, and improving quality of life.
Studies have shown that the early initiation of palliative care for patients with metastatic cancer can lead to improved pain control and symptom management, improved patient satisfaction and quality of life, reduced anxiety and delivery of care that better matches the patients’ preferences.
Value to patients
Discussing the options for palliative care with patients with metastatic breast cancer will assist them to address their physical and emotional needs and to make informed decisions about their cancer care.
Supporting evidence
Davis MP, Temel JS, Balboni T, Glare P. A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses. Annals of Palliatiative Medicine. 2015 Jul;4(3):99-121.
Howie L, Peppercorn J. Early palliative care in cancer treatment: rationale, evidence and clinical implications. Therapeutic Advances in Medical Oncology. 2013;5(6):318-23.
Parikh RB1, Kirch RA, Smith TJ, Temel JS. Early specialty palliative care - translating data in oncology into practice. New England Journal of Medicine. 2013;369(24):2347-51.
Smith TJ, Temin S, Alesi ER, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. Journal of Clinical Oncology. 2012;30(8):880-7.
Zimmermann C, Swami N, Krzyzanowska M, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383(9930):1721-30.