Turns out, palliative care interventions can help patients with depression and advanced cancer live longer. The Dartmouth-led study drew on data from two randomised controlled trials with advanced cancer patients using ENABLE (Educate, Nurture, Advise, Before Life Ends), a palliative care intervention designed to improve quality of life among patients diagnosed with cancer. Another study showed that cancer patients who decide to die at home tend to live longer.
The intervention consisted of an in-person palliative care consultation followed by six weekly structured phone coaching sessions with an advanced practice nurse specialising in palliative care. Calls then continued monthly until the patient died or the study ended. Topics covered as part of the intervention included coping strategies, symptom management and advanced care planning. The researchers compared the effect that early intervention, delayed intervention or no palliative care intervention (i.e. usual care) had on the survival rates as a function of the patient’s initial level of depression.
In general, higher levels of depression at the beginning of the study were associated with shorter survival. This was especially true for those higher in depression in the usual care group (none of whom received the palliative care intervention). In contrast, the survival rate for those higher in depression who experienced the palliative care intervention — either the early or delayed intervention — improved significantly to the point that they were similar in survival to those with low levels of depression.
The benefits of the palliative care intervention held true when demographics, the cancer site and the severity of the illness were considered. Co-lead author Jay G Hull said, “Although the effect of the palliative care intervention on survival is clear, the mechanism behind it is not. One possibility is that those who are depressed are less attentive to their health, illustrating how traditional care may be insufficient to help patients overcome this deficit. Yet, a tailored intervention may succeed by motivating health-promoting behaviours, which may enable patients to live longer.”
{{/usCountry}}The benefits of the palliative care intervention held true when demographics, the cancer site and the severity of the illness were considered. Co-lead author Jay G Hull said, “Although the effect of the palliative care intervention on survival is clear, the mechanism behind it is not. One possibility is that those who are depressed are less attentive to their health, illustrating how traditional care may be insufficient to help patients overcome this deficit. Yet, a tailored intervention may succeed by motivating health-promoting behaviours, which may enable patients to live longer.”
{{/usCountry}}Co-lead author Anna T Prescott noted that the findings should not be taken as evidence that depression causes shorter survival, but symptoms of depression could be used as a marker to help doctors identify patients who are at elevated risk for poor outcomes and who could benefit from a palliative care intervention like the one studied in this work. The study is published in journal Health Psychology.
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