In men with advanced prostate cancer, what is the evidence that referral to specialist palliative care can assist with symptom control?

From Cancer Guidelines Wiki

In men with advanced prostate cancer, what is the evidence that referral to specialist palliative care can assist with symptom control?

There was evidence that interdisciplinary palliative care can improve symptom management and enhance the wellbeing of men with metastatic prostate cancer. As far as symptom control was concerned a study involving a home nursing intervention and one involving a structured multidisciplinary intervention showed improvement in overall symptom control.[1][2] Pain management was improved in two models of co-ordinated home care[3][4]as was the symptom of dyspnoea in a nurse-led intervention[5] and with involvement of a palliative medicine team[6] . Vomiting was less frequent and more effectively treated in a study of co-ordinated care for terminally ill cancer patients.[7] Palliative interventions were shown to improve overall quality of life of the patient[2] as well as emotional wellbeing and functioning[2][3] and spiritual wellbeing.[6]Social functioning, mental and general health and vitality were improved in terminally ill patients.[3] Financial wellbeing was also improved in one study.[2]

The opinions of caregivers (family and informal carers) were sought in relation to the management of the patient’s symptoms in several studies. Increased satisfaction with the patient’s pain management was reported in one study[8][9][10], with improved caregiver satisfaction with services for symptom control shown in six studies.[3][11] [12][8][9][10][13][14][15]

Although studies failed to show consistent improvement in all domains of care, this may reflect the fact that ‘usual care’ is not equivalent to ‘no care’ and ‘usual care’ already incorporates many elements of palliative care. The improvements shown in symptom control emphasises the significant benefit of involving interdisciplinary palliative care in managing men with metastatic prostate cancer, for both the patient and family carers.

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Evidence summary and recommendations

Evidence summary Level References
There is evidence that coordinated interdisciplinary palliative care can improve symptom management and emotional, spiritual and social wellbeing in patients with advanced cancer. This finding can be generalised to men with metastatic prostate cancer. II [2], [3], [5], [1], [4], [6]
Evidence-based recommendationQuestion mark transparent.png Grade
Men with metastatic prostate cancer should be referred for interdisciplinary palliative care to assist in symptom control and in providing emotional, social and spiritual support.
C


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References

  1. 1.0 1.1 McCorkle R, Benoliel JQ, Donaldson G, Georgiadou F, Moinpour C, Goodell B. A randomized clinical trial of home nursing care for lung cancer patients. Cancer 1989 Sep 15;64(6):1375-82 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/2670188.
  2. 2.0 2.1 2.2 2.3 2.4 Rummans TA, Clark MM, Sloan JA, Frost MH, Bostwick JM, Atherton PJ, et al. Impacting quality of life for patients with advanced cancer with a structured multidisciplinary intervention: a randomized controlled trial. J Clin Oncol 2006 Feb 1;24(4):635-42 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16446335.
  3. 3.0 3.1 3.2 3.3 3.4 Department of Veterans Affairs Cooperative Study Group on Home-Based Primary Care, Hughes SL, Weaver FM, Giobbie-Hurder A, Manheim L, Henderson W, et al. Effectiveness of team-managed home-based primary care: a randomized multicenter trial. JAMA 2000 Dec 13;284(22):2877-85 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11147984.
  4. 4.0 4.1 Grande GE, Todd CJ, Barclay SI, Farquhar MC. A randomized controlled trial of a hospital at home service for the terminally ill. Palliat Med 2000 Sep;14(5):375-85 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11064784.
  5. 5.0 5.1 Moore S, Corner J, Haviland J, Wells M, Salmon E, Normand C, et al. Nurse led follow up and conventional medical follow up in management of patients with lung cancer: randomised trial. BMJ 2002 Nov 16;325(7373):1145 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12433764.
  6. 6.0 6.1 6.2 Rabow MW, Dibble SL, Pantilat SZ, McPhee SJ. The comprehensive care team: a controlled trial of outpatient palliative medicine consultation. Arch Intern Med 2004 Jan 12;164(1):83-91 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/14718327.
  7. Addington-Hall JM, MacDonald LD, Anderson HR, Chamberlain J, Freeling P, Bland JM, et al. Randomised controlled trial of effects of coordinating care for terminally ill cancer patients. BMJ 1992 Nov 28;305(6865):1317-22 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1483075.
  8. 8.0 8.1 Jordhøy MS, Fayers P, Saltnes T, Ahlner-Elmqvist M, Jannert M, Kaasa S. A palliative-care intervention and death at home: a cluster randomised trial. Lancet 2000 Sep 9;356(9233):888-93 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11036893.
  9. 9.0 9.1 Jordhøy MS, Fayers P, Loge JH, Ahlner-Elmqvist M, Kaasa S. Quality of life in palliative cancer care: results from a cluster randomized trial. J Clin Oncol 2001 Sep 15;19(18):3884-94 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/11559726.
  10. 10.0 10.1 Ringdal GI, Jordhøy MS, Kaasa S. Family satisfaction with end-of-life care for cancer patients in a cluster randomized trial. J Pain Symptom Manage 2002 Jul;24(1):53-63 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/12183095.
  11. Kane RL, Wales J, Bernstein L, Leibowitz A, Kaplan S. A randomised controlled trial of hospice care. Lancet 1984 Apr 21;1(8382):890-4 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/6143195.
  12. Hughes SL, Cummings J, Weaver F, Manheim L, Braun B, Conrad K. A randomized trial of the cost effectiveness of VA hospital-based home care for the terminally ill. Health Serv Res 1992 Feb;26(6):801-17 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/1737710.
  13. Casarett D, Karlawish J, Morales K, Crowley R, Mirsch T, Asch DA. Improving the use of hospice services in nursing homes: a randomized controlled trial. JAMA 2005 Jul 13;294(2):211-7 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/16014595.
  14. Kane RL, Berstein L, Wales J, Rothenberg R. Hospice effectiveness in controlling pain. JAMA 1985 May 10;253(18):2683-6 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/3886943.
  15. Zimmer JG, Groth-Juncker A, McCusker J. Effects of a physician-led home care team on terminal care. J Am Geriatr Soc 1984 Apr;32(4):288-92 Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/6707409.

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Appendices