Early Incorporation of Patient and Family to Attention and Care Program in Oncology Versus Standard of Care
Condition: Lung Neoplasms
MeSH terms: Lung Neoplasms
Study type: Interventional
Phase: Phase 3

Summary: 
      There is recent evidence that early palliative care administered to patients helps for their
      quality of life (QoL). It is however not part of the standard multidisciplinary treatment.

      This study intents to evaluate the effect of early palliative care in patients with advanced
      Non-Small Cell Lung Cancer (NSCLC) compared to the standard of care.
    

Detailed description: 
      The multidisciplinary approach of palliative care for symptom management has an impact on the
      quality of life (QoL) of patients and their families. The World Health Organization (WHO) and
      the American Society of Clinical Oncology (ASCO) recommend incorporating early palliative
      care, simultaneously with cancer treatment. Unfortunately, this recommendation has not been
      followed in many cancer centers and late referrals to hospice are still frequent.

      Patients with lung cancer have more symptoms than patients with other cancer. The impact on
      QoL and symptom management has acquired a great relevance. However, few studies demonstrating
      the benefit of early incorporation of palliative care in the management of patients with
      advanced lung cancer have been shown.

      Palliative care is defined as the care given to patients with progressive active and advanced
      disease, and its main purpose is the relief and prevention of suffering and improving QoL.

      In Mexico, the law defines palliative care as comprehensive care for those illnesses not
      responsive to curative treatment and include, but are not limited, to pain and other symptoms
      associated with the disease and psychological care, social and spiritual, of the patients and
      their families.

      Psychological aspects The psychological manifestations in patients with lung cancer are
      determined by several factors. Depression and anxiety are the most common psychological
      reactions. It has been identified that 25% of cancer patients suffer from major depression at
      some point during the course of the disease and has been associated with decreased survival
      and QoL. Patients with anxiety disorders become more attached to medical treatment but seek
      alternative treatments more often. The main objective of psychological interventions is
      reducing maladaptive emotional reactions. In advanced stages, caregivers also confront stress
      and depression that could lead to health problems.

      Nutritional aspects Malnutrition is reported in 60 to 79% in patients with lung cancer and is
      the largest contribution to morbidity and mortality. Cachexia is responsible directly or
      indirectly to death in one third of patients. The objectives of nutritional support are:
      improving tolerance to specific cancer treatment, decreasing the incidence of complications
      and, improving the QoL. Thus, it is necessary to conduct an early diagnosis of nutritional
      status in order to design nutritional intervention and improve their sense of comfort and
      QoL.
    

Intervention name(s): Early allocation to palliative care; Nutritional counseling; Psychoeducation.
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): Symptoms management (e.g. Pain, nausea, dehydration management).; Nutritional status evaluation and dietary supplementation according to the patient requirements.; Patient and care-taker psychoeducation, depression and anxiety evaluation.
Other intervention name(s): experimental
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Palliative Care; Survival; Quality of life