Advanced Cancer Patients with Depression Live Longer With Palliative Care

Patients with depression and advanced cancer tend to live longer when they receive a palliative care intervention, according to a new study published in the journal Health Psychology. Palliative care is designed to minimize stress and pain, provide comfort, and improve quality of life for those with severe illness.

The findings provide new insight on the association between depression and survival.

For the study, the researchers pulled data from two randomized controlled trials with advanced cancer patients receiving ENABLE (Educate, Nurture, Advise, Before Life Ends) intervention, a palliative care intervention designed to improve quality of life among patients diagnosed with cancer.

“Palliative care is still a relatively new specialty that has still not been fully incorporated into clinical practice, so studies like ENABLE provide important insights into the contributions that this multi-disciplinary specialty care can make to patients, family members, and the health systems that adopt this care model,” said senior author Marie Bakitas, associate director of the Center for Palliative and Supportive Care at the University of Alabama at Birmingham (UAB).

The intervention involved a personal consultation followed by six weekly structured phone coaching sessions with an advanced practice nurse specializing in palliative care. Topics covered in the intervention included coping strategies, symptom management, and advanced care planning. Calls continued each month until the patient died or the study ended.

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.

On average, higher levels of depression at the onset of the study were tied to shorter survival. This was particularly true for those with greater depression in the usual care group (none of whom received the palliative care intervention).

In contrast, the survival rate for highly depressed patients in 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 results remained true even after the researchers factored in demographics, the cancer site, and the severity of the illness.

“Although the effect of the palliative care intervention on survival is clear, the mechanism behind it is not,”  said co-lead author Dr. Jay G. Hull, the Dartmouth Professor of Psychological and Brain Sciences, and associate dean of faculty for the social sciences.

“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 behaviors, which may enable patients to live longer.”

Source: Dartmouth College

Posted by Patricia Adams