Zusammenfassung
Hintergrund
Die Therapieziele beim metastasieten Lungenkarzinom sind i. d. R. palliativ, sodass die Symptomkontrolle und die Verbesserung der Lebensqualität neben der Lebenszeitverlängerung an vorderster Stelle stehen. Die hier vorgestellte randomisierte Studie von Temel et al. zeigte, dass eine frühzeitige palliative Intervention Symptome verringern, die Lebensqualität steigern und das Überleben verlängern kann.1
Fragestellung
Es wurde der Effekt einer frühen palliativen Intervention in der Betreuung am Lebensende auf die Lebensqualität bei ambulanten Patienten mit neu diagnostiziertem metastasiertem Lungenkarzinom evaluiert.
Material und Methode
Patienten mit neu diagnostiziertem metastasiertem nichtkleinzelligem Lungenkarzinom wurden randomisiert entweder einer onkologischen Standardtherapie oder zusätzlich zur Standardtherapie einer palliativen Intervention zugeführt. Lebensqualität und psychisches Befinden wurden bei Einschluss und nach 12 Wochen mittels Functional-Assessment-of-Cancer-Therapy-Lung(FACT-L)-Test und der Hospital-anxiety-and-depression-Skala (HADS) ausgewertet. Primärer Endpunkt war die Veränderung in der Lebensqualität nach 12 Wochen. Die Daten zur Betreuung am Lebensende wurden aus der elektronischen Patientenakte entnommen.
Ergebnisse
In der Interventionsgruppe war die Lebensqualität signifikant verbessert und die Rate an Depressionen verringert. Die Betreuung am Lebensende war weniger aggressiv und hospizliche Einrichtungen waren häufiger und früher involviert. Zudem war das Überleben signifikant verlängert.
Diskussion
Diese Daten unterstützen den Ansatz, die Palliativversorgung durch eine multiprofessionelles Team frühzeitig in die Betreuung der Patienten mit neu diagnostiziertem metastasiertem Lungenkarzinom einzubinden.
Abstract
Background
Many patients with metastatic lung cancer suffer from physical and psychological symptoms as well as of social and spiritual concerns. The goals of therapy are usually palliative. Factors like symptom control and quality of life are important in addition to prolonged survival in these circumstances. The randomised trial by Temel et al. presented here shows that early palliative care can reduce symptoms, improve quality of life and prolong survival.
Objectives
The effect of early palliative care on quality of life and end-of-life care among ambulatory patients with newly diagnosed metastatic lung cancer was evaluated.
Materials and methods
Patients with newly diagnosed metastatic lung cancer were randomised to treatment with standard therapy or standard therapy plus early palliative care. Quality of life and mood were assessed at baseline and at 12 weeks with the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale and the Hospital Anxiety and Depression Scale (HADS). The primary outcome was the change in quality of life at 12 weeks. The data of end-of-life care were collected from electronic medical records.
Results
The palliative care group had significantly better quality of life and less depression. The end-of-life care was less aggressive and hospice care was integrated earlier and more often. The survival time was significantly prolonged.
Conclusion
These data support the approach to integrate palliative care by a multiprofessional team early in the therapeutic concept for patients with newly diagnosed metastatic lung cancer.
Literatur
Bausewein C, Simon ST (2013) Shortness of breath and cough in patients in palliative care. Dtsch Arztebl Int 110(33–34):563–572
Curtis JR, Engelberg R, Young JP et al (2008) An approach to understanding the interaction of hope and desire for explicit prognostic information among individuals with severe chronic obstructive pulmonary disease or advanced cancer. J Palliat Med 11(4):610–620
D’Addario G, Früh M, Reck M et al (2010) Metastatic non-small-cell lung cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 21(Suppl 5):v116–v119
Earle CC, Park ER, Lai B et al (2003) Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol 21:1133–1138
El-Jawahri A, Greer JA, Temel JS (2011) Does palliative care improve outcomes for patients with incurable illness? A review of the evidence. J Support Oncol 9:87–94
Goeckenjan G, Sitter H, Thomas M et al (2010) Prävention, Diag-nostik, Therapie und Nachsorge des Lungenkarzinoms. Interdis-ziplinäre S3-Leitlinie der Deut-schen Gesellschaft für Pneumo-logie und Beatmungsmedizin und der Deutschen Krebsgesellschaft. Pneumologie 64(Suppl):23–155
Greer JA, Jackson VA, Meier DE et al (2013) Early integration of palliative care services with standard oncology care for patients with advanced cancer. CA Cancer J Clin 63:349–363
Greer JA, Pirl WF, Jackson VA (2012) Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non–small-cell lung cancer. J Clin Oncol 30:394–400
Hanna N, Shepherd FA, Fossella FV et al (2004) Randomized phase III trial of pemetrexed versus docetaxel in patients with non-small-cell lung cancer previously treated with chemotherapy. J Clin Oncol 22:158
Irwin KE, Greer JA, Khatib J et al (2013) Early palliative care and metastatic non-small cell lung cancer: potential mechanisms of prolonged survival. Chron Respir Dis 10:35
Lordick F, Oorschot B van (2012) Palliativmedizin in der Onkologie, Ziele der Arbeitsgemeinschaft Palliativmedizin der Deutschen Krebsgesellschaft. FORUM 27:367–371
Mack JW, Cronin A, Keating NL et al (2012) Associations between end-of-life discussion character-istics and care received near death: a prospective cohort study. J Clin Oncol 30:4387-43959-1597
Maione P, Perrone F, Gallo C et al (2005) Pretreatment quality of life and functional status assessment significantly pre-dict survival of elderly patients with advanced non-small cell lung cancer receiving chemothera-py: a prognostic analysis of the multicenter italian lung cancer in the elderly study. J Clin Oncol 23:6865–6872
Movsas B, Moughan J, Sarna L et al (2009) Quality of life super-sedes the classic prognosticators for longterm survival in local-ly advanced non-small cell lung cancer: an analysis of RTOG 9801. J Clin Oncol 27:5816–5822
NCCN Guidelines Palliative Care, Version 2.2013, NCCN.org
Paz-Ares L, Marinis F de, Dediu M et al (2012) Maintenance thera-py with pemetrexed plus best sup-portive care versus placebo plus best supportive care after induc-tion therapy with pemetrexed plus cisplatin for advanced non-squamous non-small-cell lung cancer (PARAMOUNT): a double-blind, phase 3, randomised con-trolled trial. Lancet Oncol 13:247–255
Peppercorn JM, Smith TJ, Helft PR et al (2011) American society of clinical oncology statement: toward individualized care for patients with advanced cancer. J Clin Oncol 29:755–760
Pirl WF, Temel JS, Billings A et al (2008) Depression after diag-nosis of advanced non-small cell lung cancer and survival: a pilot study. Psychosomatics 49:218–224
Rodrigues G, Macbeth F, Burmeister B et al (2012) Consensus statement on palliative lung radiotherapy: third international consensus workshop on palliative radiotherapy and symptom control. Clin Lung Cancer 13:1–5
Rosell R, Carcereny E, Gervais R et al (2012) Erlotinib versus standard chemotherapy as first-line treatment for European patients with advanced EGFR mutation-positive non-small-cell lung cancer (EURTAC): a multi-centre, open-label, randomised phase 3 trial. Lancet Oncol 13:239–246
Saito AM, Landrum MB, Neville BA et al (2011) The effect on survival of continuing chemo-therapy to near death. BMC Palliat Care 10:14
Scagliotti GV, Parikh P, Pawel J von et al (2008) Phase III study comparing cisplatin plus gem-citabine with cisplatin plus pe-metrexed in chemotherapy-naive patients with advanced-stage non-small-cell lung cancer. J Clin Oncol 26:3543–3551
Shaw A, Kim DW, Nakagawa K et al (2013) Crizotinib versus chemotherapy in advanced ALK-positive lung cancer. N Engl J Med 368:2385–2394
Smith TJ, Temin S, Alesi ER et al (2012) American society of clinical oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol 30:880–887
Soria J-C, Mauguen A, Reck M et al (2013) Systematic review and meta-analysis of randomised, phase II/III trials adding bevacizumab to platinum-based chemotherapy as first-line treatment in patients with advanced non-small-cell lung cancer. Ann Oncol 24:20–30
Steins MB (2012) Frühe palliative Führung – Stellen-wert beim metastasierten Lun-genkarzinom. Pneumologe 9:120–122
Temel JS, Greer JA, Admane S et al (2011) Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non–small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol 29:2319–2326
Temel JS, Greer JA, Muzikansky A et al (2010) Early palliative care for patients with metastatic non–small-cell lung cancer. N Engl J Med 363:733–742
Einhaltung ethischer Richtlinien
Interessenkonflikt. C. Eschbach, D. Heigener, W. Nehls, M. Villalobos und B. van Oorschot geben an, dass kein Interessenkonflikt besteht.
Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Eschbach, C., Heigener, D., Nehls, W. et al. Frühe palliative Intervention. Onkologe 20, 998–1002 (2014). https://doi.org/10.1007/s00761-014-2675-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00761-014-2675-5