An imprecise description of what the investigators did in this study could lead readers to badly misinterpret the conclusions and implications of the research. In addition, the story focused excessively on the survival benefit reported, when there were actually other — arguably just as important — effects on on patients’ quality of life and risk of depression.
Palliative care focuses on symptom relief and providing support for patients with terminal illness. It is usually offered only late in the course of treatment for advanced cancer and other incurable diseases. Some accordingly view the approach as tantamount to "giving up hope" and possibly even hastening a patient’s death. But the new study covered here suggests that far from hastening death, patients with lung cancer who receive early palliative care in addition to standard care actually survive longer than patients who receive standard care alone. They also feel better and are subjected to fewer aggressive medical procedures in their final days. The implication– pending confirmation from additional studies–is that earlier palliative care could help terminally ill patients live better and longer lives. It may also help curtail the estimated $50 billion that Medicare spends on care for patients in their last two months of life.
No discussion of costs here. Coverage and reimbursement of treatment is one important aspect of this issue as noted above. Another is whether palliative care actually saves money for the health care system as a whole. As other news organizations noted, the results suggest that palliative care patients use fewer aggressive treatments at the end of life in a futile attempt to extend their lives. This suggests that palliative care might save the system money; however, we don’t yet know if the savings are enough to offset the increased cost of the palliative care itself.
This story — like many aspects of our medical system — focuses on survival to the exclusion of almost all else. But prolonged life was just one of many benefits that the researchers attributed to early palliative care in this study. Other notable outcomes of the study included improvement in quality of life and reduction in depression scores. Considering that terminally ill patients have concerns that go well beyond merely prolonging their lives (e.g. avoiding suffering, remaining mentally competent, not being a burden on others, etc), we think the story should have at least mentioned these outcomes.
We’ll call this one not applicable even though the story didn’t mention harms. While we don’t mean to suggest that palliative care is incapable of causing adverse effects (opioid painkillers can cause constipation; other palliative approaches can involve chemotherapy, radiation, and surgery, which obviously have the potential to cause harm), for the most part palliative care is focused on mitigating the adverse effects of more aggressive cancer treatments and helping patients cope and make decisions. The potential for harm in all this is generally considered minimal.
Unlike the competing stories, USA Today never explicitly tells us that patients in the palliative care group also received the same standard medical care (chemo, etc) that the control group received. That’s a key issue about the study design. So, readers may easily misconstrue this as meaning that palliative care alone — without these other treatments — can extend lives compared to the usual, often-arduous medical care that cancer patients receive. It would be an unfortunate misinterpretation if people thought that Western approaches to cancer treatment do more harm than good and should be avoided. This is certainly not what the study shows.
There was also a missed opportunity to explore the reasons why palliative care may extend life. As some of the other stories noted, some researchers believe that palliative care may help patients tolerate more harsh cancer treatments than they would be otherwise be able to stomach. It may be a synergistic effect with traditional treatment — and not the specific effects of palliative care itself — which are helpful for prolonging survival.
No evidence of disease-mongering.
The sourcing of this story was one of its strengths. It quotes a researcher involved with the study, an accompanying editorial, and two independent experts.
The point of the study was to compare early palliative care with existing standard cancer treatment. However, we think this story could have provided a bit more detail regarding what standard cancer care — the current existing alternative — entails.
The story notes that palliative care is available at 80% of large hospitals but that many physicians fail to make use of it. The upshot is that many patients don’t know it’s available to them and can’t access it. This story, like the others, however, misses the difference between availability of palliative care in the inpatient/acute care setting and availability in the outpatient setting, which is what was studied here. The story also could have noted cost and reimbursement barriers that the competing New York Times piece also mentioned, but we think it’s enough that the story at least raised the issue of availability. It’s more information than was provided by some other outlets covering the study.
The story notes that the "landmark" aspect of the study was the fact that researchers gave palliative care early after diagnosis as opposed to in the final days of life. This is an accurate characterization. It also could have noted that study was a rare randomized controlled study of palliative care, which provides stronger evidence than other types of studies.
It’s clear this story didn’t rely on a press release.