Early Palliative Care

Investigate the effect of receiving early palliative care (EPC) on changes in depression from baseline to 12 weeks and the possible impact that treatment of depression may have on survival.

For parent study patients in an outpatient thoracic oncology clinic were approached for study participation and assessed for eligibility by the clinic medical oncologists. Consented patients were randomly assigned to EPC with standard of care or standard care alone. Patients in EPC group met with a certified member of the palliative care team within 3 months of enrollment and monthly thereafter until death. The standard care group only met with palliative care upon request.

AGE  mean age 64.4 (9.6)

MALES (%) 48.3   FEMALES (%) 51.7  

KEY DISEASE CHARACTERISTICS  within 8 weeks of diagnosis with NSCLC

OTHER KEY SAMPLE CHARACTERISTICS  ECOG score of 0-2, English speaking, not already receiving palliative care
 

SITE Single site   SETTING TYPE Outpatient setting   LOCATION Massachusetts General Hospital; Boston MA
 

PHASE OF CARE End of life care

APPLICATIONS End of Life and Palliative Care
 

Secondary analysis of clinical trial data

• PHQ-9 (Depression questionnaire): Major depression syndrome (MDS) measured at baseline and 12 weeks.    
• Survival: calculated by time of enrollment until death or time of censoring data  
   

At baseline, 14% of the sample met criteria for Major Depressive Syndrome (MDS).  Median survival was shorter for patients with MDS at baseline. (5.4 months for those with MDS versus 10 months for those without MDS; p=.001). This remained after controlling for demographic variables (p=.02). PHQ-9 scores were also associated with survival, controlling for demographic factors (p<.001). Participants in the EPC group had greater improvement in PHQ-9 scores from baseline to 12 weeks compared to the standard of care group, with a mean score change of -0.96 ± 4.53 (SD). In patients with baseline MDS ( 21 patients ) those in the EPC group had greater rates of depression response at 12 weeks than the standard of care group (p=.04). Rates of new antidepressant prescriptions and mental health visits did not differ significantly between groups.

Depression is associated with survival in this sample of NSLC patients. EPC was shown to slightly improve depression score in patients with MDS scores at 3 months.

No appropriate control group

Due to the exploratory methods of the secondary analysis study causality of survival or the depression outcome cannot be inferred from the results. There is limited data to support that the intervention is associated with survival benefit related to depression.  The study was carried out at a single site which limits generalizabilty. The control group did not have any attention control intervention also limiting interpretation of study results. Impact on depression scores was only seen in 21 patients who had MDS at baseline, and the change in score was very small, with very high variability as shown by the standard deviation.  Standard care was stated to include palliative care upon patient request - the number of those who did request and also receive palliative care is not reported
 

Conclusions from this study are difficult to interpret into specific nursing intervention. Findings suggest that for those patients with a major depressive disorder, earlier and proactive involvement of a palliative care team might be of benefit in managing the depression.