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http://www.nejm.org/doi/full/10.1056/NEJMoa1000678#t=abstract


Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer
Jennifer S. Temel, M.D., Joseph A. Greer, Ph.D., Alona Muzikansky, M.A., Emily R. Gallagher, R.N., Sonal Admane, M.B., B.S., M.P.H., Vicki A. Jackson, M.D., M.P.H., Constance M. Dahlin, A.P.N., Craig D. Blinderman, M.D., Juliet Jacobsen, M.D., WilliamF. Pirl, M.D., M.P.H., J. Andrew Billings, M.D., and Thomas J. Lynch, M.D.
N Engl J Med 2010; 363:733-742August 19, 2010DOI: 10.1056/NEJMoa1000678
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BACKGROUND
Patients with metastatic non–small-cell lung cancer have a substantial symptom burden and may receive aggressive care at the end of life. We examined the effect ofintroducing palliative care early after diagnosis on patient-reported outcomes and end-of-life care among ambulatory patients with newly diagnosed disease.

METHODS
We randomly assigned patients with newly diagnosed metastatic non–small-cell lung cancer to receive either early palliative care integrated with standard oncologic care or standard oncologic care alone. Quality of life and mood wereassessed at baseline and at 12 weeks with the use of the Functional Assessment of Cancer Therapy–Lung (FACT-L) scale and the Hospital Anxiety and Depression Scale, respectively. The primary outcome was the change in the quality of life at 12 weeks. Data on end-of-life care were collected from electronic medical records.

RESULTS
Of the 151 patients who underwent randomization, 27 died by 12 weeksand 107 (86% of the remaining patients) completed assessments. Patients assigned to early palliative care had a better quality of life than did patients assigned to standard care (mean score on the FACT-L scale [in which scores range from 0 to 136, with higher scores indicating better quality of life], 98.0 vs. 91.5; P=0.03). In addition, fewer patients in the palliative care group than in thestandard care group had depressive symptoms (16% vs. 38%, P=0.01). Despite the fact that fewer patients in the early palliative care group than in the standard care group received aggressive end-of-life care (33% vs. 54%, P=0.05), median survival was longer among patients receiving early palliative care (11.6 months vs. 8.9 months, P=0.02).

CONCLUSIONS
Among patients with metastaticnon–small-cell lung cancer, early palliative care led to significant improvements in both quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival. (Funded by an American Society of Clinical Oncology Career Development Award and philanthropic gifts; ClinicalTrials.gov number, TRADUCCION

Cuidados Paliativos temprana para pacientes con cáncer de pulmón no microcítico Cáncer de Pulmón
Jennifer S. Temel, MD, Joseph A. Greer, Ph.D., Alona Muzikansky, MA, Emily R. Gallagher, RN, Sonal Admane, MB, BS, MPH, Vicki A. Jackson, MD, MPH, Constance M. Dahlin, APN, Craig D. Blinderman, MD, Juliet Jacobsen, MD, William F. Pirl, MD, MPH, J. Andrew Billings, MD, y Thomas J. Lynch, MD
NEngl J Med 2010; 363:733-742 19 de agosto 2010 DOI: 10.1056/NEJMoa1000678
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La calidad de la atención y el uso de los servicios médicos para los pacientes gravemente enfermos son elementos clave en el actual debate sobre la reforma del sistema de atención de salud de EE.UU.. 1 cuidado oncológico es central en estedebate, en gran parte debido a los tratamientos contra el cáncer son a menudo intensiva y costosa. 2 servicios oncológicos integrales para pacientes con enfermedad metastásica idealmente mejorar la calidad de vida de los pacientes y facilitar la asignación eficiente de los recursos médicos. Los cuidados paliativos, con su enfoque en la gestión de los síntomas, el apoyo psicosocial y asistencia en...