Early Incorporation of Patient and Family to Attention and Care Program in Oncology Versus Standard of Care (PACO vs SC)

The multidisciplinary approach of palliative care for symptom management like psychological, emotional, spiritual, nutritional, among others, has an impact on the quality of life of patients and their families. Based on the foregoing, the World Health Organization (WHO) and the American Society of Clinical Oncology (ASCO) recommend incorporating early palliative care, simultaneously with cancer treatments. Unfortunately, this recommendation has not been incorporated in many cancer centers and late referrals to hospice are still frequent.

Lung cancer is the leading cause of cancer death worldwide, according to the literature, patients with lung cancer have more symptoms (arising from their disease, metastasis or comorbidities), than patients with other cancers. In this context, the impact on quality of life 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 quality of life.

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 Cancer is a disease that causes the greatest impact on the sufferer and the family, the impact occurs at different levels. The psychological manifestations in patients with lung cancer are determined by the clinical stage of disease, physical symptoms and treatments received, are depression and anxiety the most common psychological reactions. It has been identified that a quarter of cancer patients suffer from major depression at some point during the course of the disease. Depression has been associated with decreased survival and which strongly influences the evolution of lung cancer and quality of life. Patients with anxiety disorders become more attached to medical treatment but seek more alternative treatments far more often, and could interfere with treatment. Lung cancer is accompanied by a number of symptoms affecting negatively the quality of life of patients. The main objective of psychological interventions is reducing maladaptive emotional reactions.

Mainly in advanced stages, challenges are present for caregivers, including stress and depression, impacting on health problems and long term.

Nutritional aspects Malnutrition is reported in 60 to 79% in patients with lung cancer and is the largest contribution to morbidity and mortality. The highest expression of malnutrition in cancer is cachexia, which is responsible directly or indirectly to death in one third of patients. The objectives of nutritional support are improving tolerance to specific cancer treatment, decrease the incidence of complications and, above all, improve the quality of life. Thus it is necessary to conduct an early diagnosis of nutritional status. The terminal and palliative care diet plan must be designed to improve their sense of comfort and better quality of life.

Therefore patients included early in palliative care have better quality of life and survival.