Palliative care: Quality of life ‘keeps cancer therapy on track’

Palliative care might better be termed ‘supportive care’

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In the lexicon of oncology, palliative care — non-curative treatment for pain and other symptoms of cancer — is sometimes seen as a byword for surrender.

Patients and their families prefer to talk about “fighting cancer” while medics and pharmaceuticals companies measure success by how many extra months or years of life can be achieved.

Yet, these attitudes are being challenged by research highlighting the importance of quality of life during cancer treatment.

“Too often palliative care has been associated with death and dying, a loss of control or abandoning hope,” says Anthony Caprio, a palliative care specialist at Carolinas HealthCare System in North Carolina.

As well as pain relief, palliative care can include medicines to help cope with the side-effects of cancer drugs, and therapy for the psychological distress caused by the disease.

Several clinical studies have shown that early palliative care increases quality of life for patients and satisfaction with their treatment. Some research suggests it could improve outcomes. A 2010 study in the New England Journal of Medicine found that patients with advanced lung cancer who received early palliative care had almost three months’ longer median survival than those receiving standard care, as well as higher quality of life and lower levels of depression.

Some patients continue to resist palliative care because of the stigma attached to it. A study published in April in the Canadian Medical Association Journal split 48 people with advanced cancer into two groups, only one of which received palliative care in addition to standard treatment. In interviews at the beginning of the study, both groups associated palliative care with giving up and dying. By the end of the study, opinions had diverged. The group receiving palliative care had come to see it positively as a way to live life to the fullest, whereas the other group continued to view it negatively.

Dr Caprio says palliative care’s stigma could be overcome by rebranding it as “supportive care” and integrating it as a normal part of cancer treatment from the point of diagnosis — rather than something that is reserved for the last few months of life.

There are signs of the medical community gradually embracing this message. A paper in the New England Journal of Medicine last year found that the number of palliative care programmes in the US has more than doubled in the past decade.

The MD Anderson Cancer Center in Houston, one of the top US cancer research centres, last month agreed a strategic alliance with Helsinn, the Swiss pharmaceuticals group, to research new approaches to supportive care for cancer symptoms and side-effects such as weight loss, fatigue, diarrhoea, nausea and pain.

“There is more and more interest among the oncology community in quality of life,” says Riccardo Braglia, Helsinn chief executive. “Extending life by three or six months only makes sense if it comes with a good quality of life.”

Helsinn, family-owned, is one of several small and midsized companies focused on supportive care drugs, an area which Mr Braglia says “big pharma” has neglected in favour of higher-margin cancer medicine. Helsinn is the biggest producer of treatments for the nausea and vomiting experienced by most chemotherapy patients. Other companies in supportive care include Heron Therapeutics of the US and Acacia Pharma of the UK.

Globally it is a market forecast to grow at an annual compound rate of 4.3 per cent between 2015 and 2021, from $23.6bn to $31.7bn, says Persistence Market Research. This is about 20 per cent of the broader oncology market.

An ageing world population is leading to more elderly cancer patients, for whom supportive care is especially important. This trend is true of big emerging markets as well as the developed world. Helsinn is expanding its operations in China where cancer rates are soaring due to changing demographics and lifestyles.

Supportive care companies face a battle to maintain their share of oncology spending at a time when a wave of life-extending cancer drugs are reaching market, with price tags of $100,000 a year or more.

“It is a threat because new [anti-cancer] agents are coming out at very high prices and this takes away a lot of budget,” says Mr Braglia.

He argues that supportive care should be seen as an essential companion of new cancer drugs, the side-effects of which can force a reduced dose or halt treatment altogether. “Good supportive care helps patients keep their treatment on track.”

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