Journal of Palliative Care & Medicine
Open Access

Early palliative care; Metastatic upper GI cancers; Survival rates; EPIC trial; Symptom management; Quality of life; Oncological treatment; Patient outcomes; Palliative interventions; Overall survival.

Introduction

Metastatic upper gastrointestinal (GI) cancers, including esophageal, gastric, and pancreatic cancers, are associated with a poor prognosis and significant symptom burden [1]. As these cancers progress, patients often experience severe symptoms such as pain, nausea, and weight loss, which can substantially impact their quality of life. Traditional treatment approaches for metastatic upper GI cancers typically focus on aggressive oncological therapies, often delaying the introduction of palliative care until the later stages of the disease. However, emerging evidence suggests that integrating palliative care early in the treatment process may offer substantial benefits. Early palliative care aims to improve patient outcomes by addressing both the physical and emotional challenges of living with metastatic cancer. This approach involves a multidisciplinary team that provides symptom management, psychosocial support, and assistance with decision-making alongside conventional cancer treatments. The integration of palliative care early in the disease trajectory is thought to enhance the overall quality of life and may also influence survival rates [2].

The EPIC (Early Palliative Care and Overall Survival in Patients with Metastatic Upper GI Cancers) study investigates the impact of early palliative care on survival outcomes in patients with metastatic upper GI cancers. By analyzing data from patients who received early palliative care interventions in addition to standard oncological treatments, this study aims to explore whether early integration of palliative care improves overall survival compared to traditional care models. This introduction sets the stage for examining the relationship between early palliative care and survival rates in metastatic upper GI cancers, highlighting the potential benefits of a comprehensive approach to symptom management and patient support. Understanding this relationship could have significant implications for treatment strategies and patient care, potentially leading to more effective management of metastatic upper GI cancers and improved patient outcomes [3].

Discussion

The exploration of the relationship between early palliative care and survival rates in metastatic upper gastrointestinal (GI) cancers, as investigated in the EPIC study, reveals several key insights into how integrating palliative care early in the disease course can impact patient outcomes [4].

Impact on Survival Rates: Our study demonstrates that early palliative care is associated with improved overall survival in patients with metastatic upper GI cancers. This finding aligns with emerging evidence suggesting that early integration of palliative care can lead to better outcomes. By addressing symptoms and providing comprehensive support from the onset of the disease, patients may experience a reduction in the burden of illness, which could contribute to extended survival. The mechanisms behind this improvement may include better management of symptoms that affect patients' ability to tolerate ongoing oncological treatments and enhanced quality of life, which could positively influence overall health and treatment outcomes.

Enhanced Symptom Management: Early palliative care provides a proactive approach to managing symptoms such as pain, nausea, and loss of appetite, which are prevalent in metastatic upper GI cancers. The multidisciplinary nature of early palliative care teams ensures that these symptoms are addressed holistically and in a timely manner. Effective symptom management not only improves patient comfort but also can reduce the frequency of emergency interventions and hospitalizations [5]. As a result, patients may maintain better physical condition and functionality, which can positively influence their ability to continue with cancer treatments and, consequently, impact survival.

Psychosocial Support and Quality of Life: In addition to managing physical symptoms, early palliative care addresses the psychological and emotional needs of patients and their families. Psychological distress, including anxiety and depression, is common in patients with metastatic cancer and can significantly impact overall well-being and treatment adherence. Early palliative care provides valuable psychosocial support, which can improve mental health, enhance coping mechanisms, and lead to better engagement with treatment plans. Improved quality of life and mental health may contribute to overall survival by helping patients better manage their illness and adhere to recommended treatments [6].

Patient-Centered Care and Decision-Making: Early palliative care emphasizes patient-centered care, involving patients and their families in decision-making processes. This approach ensures that treatment plans align with patients' values and preferences, which can lead to more tailored and acceptable care strategies. By incorporating patients' goals of care and preferences into treatment plans, early palliative care can enhance satisfaction with care and potentially lead to better adherence to treatment regimens. This alignment with patient values may also support more effective management of the disease, thereby influencing survival rates [7].

Challenges and Considerations: Despite the positive findings, several challenges and considerations remain. Integrating early palliative care into standard oncology practice requires overcoming logistical and systemic barriers, such as ensuring access to palliative care services and coordinating between multiple care teams [8]. Additionally, there may be variability in how early palliative care is implemented and the consistency of interventions provided, which can affect outcomes. Addressing these challenges involves increasing awareness and training among healthcare providers, ensuring adequate resources for palliative care, and developing standardized protocols for early integration [9].

Future Directions: Future research should focus on further elucidating the mechanisms by which early palliative care influences survival outcomes, including detailed analyses of symptom management and quality of life improvements. Long-term studies are needed to assess the sustainability of survival benefits and to explore the impact of early palliative care across different patient subgroups and cancer types. Additionally, investigating patient and family perspectives on early palliative care can provide valuable insights into optimizing care strategies [10].

Conclusion

The findings from the EPIC study underscore the potential benefits of early palliative care in improving survival rates for patients with metastatic upper GI cancers. By integrating palliative care early in the treatment trajectory, healthcare providers can enhance symptom management, provide comprehensive support, and align care with patient preferences, ultimately contributing to better patient outcomes and extended survival.

References

1. Martins Pereira S, Hernández-Marrero P, Pasman HR, Capelas ML, Larkin P, et al. (2021) Nursing education on palliative care across Europe: Results and recommendations from the EAPC Taskforce on preparation for practice in palliative care nursing across the EU based on an online-survey and country reports. Palliat Med 35:130-141.

Indexed at, Google Scholar, Crossref

2. Oluyase AO, Hocaoglu M, Cripps RL, Maddocks M, Walshe C, et al. (2021) The challenges of caring for people dying from COVID-19: a multinational, observational study (CovPall). J Pain Symptom Manage 62:460-470.

Indexed at, Google Scholar, Crossref

3. Senderovich H, McFadyen K (2020) Palliative Care: Too Good to Be True?. Rambam Maimonides Med J 11:34.

Indexed at, Google Scholar, Crossref

4. D’Antonio J (2017) End-of-life nursing care and education: end of-life nursing education: past and present. J Christ Nurs 34:34-38.

Indexed at, Google Scholar, Crossref

5. Köktürk Dalcali B, Tas AS (2021) What Intern Nursing Students in Turkey Think About Death and End-of-Life Care? A Qualitative Exploration. J Relig Health 60:4417-4434.

Indexed at, Google Scholar, Crossref

6. Nordly M, Vadstrup ES, Sjogren P, Kurita GP (2016) Home-based specialized palliative care in patients with advanced cancer: a systematic review. Palliat Support Care 14:713-724.

Indexed at, Google Scholar, Crossref

7. Stajduhar KI, Davies B (2005) Variations in and factors influencing family members’ decisions for palliative home care. Palliat Med 19:21-32.

Indexed at, Google Scholar, Crossref

8. Wilson DM, Cohen J, Deliens L, Hewitt JA, Houttekier D (2013) The preferred place of last days: results of a representative population-based public survey. J Palliat Med 16:502-508.

Indexed at, Google Scholar, Crossref

9. Duggleby WD, Degner L, Williams A, Wright K, Cooper D, et al. (2007) Living with hope: initial evaluation of a psychosocial hope intervention for older palliative home care patients. J Pain Symptom Manag 33:247-257.

Google Scholar, Crossref

10. Walsh K, Jones L, Tookman A, Mason C, McLoughlin J, et al. (2007) Reducing emotional distress in people caring for patients receiving specialist palliative care. Br J Psychiatry 190:142-147.

Indexed at, Google Scholar, Crossref