Dr. David Tribble

The New England Journal of Medicine published a study recently in which 151 lung cancer patients received either usual treatment or usual treatment plus palliative care. The palliative care recipients had better quality of life scores; were more likley to have decided against resuscitation; received less chemotherapy; and survived, on average, almost 3 months longer.

Previously, a study has shown that the simple act of a clear conversation about prognosis and options led to better symptom control and fewer oncologic interventions without shorter survival.  Another showed that for patients with 5 specified cancers and congestive heart failure, hospice care is associated with a longer survival.

We who practice palliative medicine do so not because we support giving up, but because we have experienced the improvement in life that comes with adequate symptom control, and with thoughtful decision-making on the value of some therapies whose life-prolonging benefits are open to question.

Now we have, in multiple studies, solid evidence that palliative medicine not only does NOT shorten survival, but actually is the best chance of extending it for some.

Electing palliative care is not an act of surrender. It is, for many, the best opportunity for survival that is not only the most comfortable, but also the longest. Active medical intervention for cure or disease modification does not necessarily equate to longer survival or to better qualitative survival.

I look forward to the concurrent care demonstration projects (a combination of curative and hospice care), both for the opportunity to provide good palliation (comfort measures) to those not yet ready to abandon disease-modifying treatment and for the opportunity to look at this survival issue on a much larger scale.

Dr. David Tribble is Alive Hospice’s chief medical officer.