Palliation in Interventional Oncology: An Update

Interventional oncology (IO) offers many benefits to cancer patients when it is provided in collaboration with medical oncology, surgical oncology, and radiation oncology and has been referred to as the fourth pillar of cancer care.¹ This branch of interventional radiology relies on staying current in cancer care concepts and on incorporating clinical care of these patients.  

Historically, IO procedures were offered for end-stage palliation when all other forms of management had been exhausted. Now, with the support of evidence-based studies, these procedures have become incorporated earlier into therapeutic care algorithms. The focus of many of our procedures, however, remains non-curative and thus palliative. Interventional oncology patients and interventional radiology patients scheduled for complex procedures benefit from evaluation in a dedicated clinic.

Palliative care is also a fundamental component of cancer care. Traditionally, this was also relegated to end-of-life care. This model, just like IO, is changing. Palliative care has become incorporated earlier in the continuum of care because early access to palliative care has resulted in improved outcomes and longer survival in patients with chronic illness, including cancer.  

Palliative care is defined by the World Health Organization (WHO) as “an approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”² Modern palliative cancer care attempts to integrate cancer symptom care with disease-centered care for the patient throughout their disease. As such, palliative care perhaps should be considered as the foundation or base of comprehensive cancer care (Figure 1) and patient and family treatment is optimized throughout their disease process.

Several evidence-based studies have been published showing that early incorporation of palliative care concepts and early palliative care referral improves quality of life, may improve survival, and improves caregiver outcomes.^3-7 This also decreases aggressive therapeutic measures at end of life. Temel et al challenged the long-held belief that palliative care was only for patients with end-stage disease.⁴ This study randomly assigned 151 ambulatory patients with newly diagnosed metastatic non–small-cell lung cancer to receive palliative care integrated with standard oncologic care or standard oncologic care alone. Patients who received early palliative care, even though they received less aggressive end-of-life care, survived longer than patients receiving standard care (median 11.6 vs 8.9 months; P=.02).⁴ Patients in the early palliative care group had a better quality of life (mean score on the Functional Assessment of Cancer Therapy-Lung scale, 98.0 vs 91.5; P=.03) and were also less likely to have depressive symptoms (16% vs 38%; P=.01). 

Interventional oncology patients are often referred from other services. It is important to educate these referring physicians on the breadth of procedures offered and other capabilities of the interventional radiology department in order to initiate timely and appropriate consultations. This open communication will allow clinicians to utilize our procedures earlier in their patients’ treatment algorithms.

Conversely, many patients come to the interventional oncology clinic manifesting common cancer symptoms. Often, the patient’s oncologist or management team is already addressing these, but sometimes symptoms are new or have progressed since the patient’s prior medical visits. If we, as physicians, inquire into and evaluate these symptoms, we can often initiate treatment or consultation and thus improve our patient’s quality of life.  

To accomplish this, review of the most common cancer symptoms, introduction of a reproducible means of evaluating the patient, and use of simplified management algorithms that fit into the scope of practice of interventional radiology will allow better care and outcomes for the oncology patient in the interventional oncology clinic.

References

1. van den Bosch MA, Prevoo W, van der Linden EM, et al. The radiologist as the treating physician for cancer: interventional oncology [article in Dutch]. Ned Tijdschr Geneeskd. 2009;153:A532.
2. World Health Organization. WHO definition of palliative care. https://www.who.int/cancer/palliative/definition/en/. Accessed September 21, 2016.
3. Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302:741-749.
4. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363:733-742.
5. Wright AA, Zhang B, Ray A, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300:1665-1673. 
6. Kane RL, Wales J, Bernstein L, Leibowitz A, Kaplan S. A randomised controlled trial of hospice care. Lancet. 1984;1:890-894. 
7. 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;19:3884-3894.

Editor’s note: This article first appeared in the Synergy Daily conference newspaper, available to attendees of the Synergy Miami interventional oncology meeting in November 2016. This article did not undergo peer review. Dr Echenique can be reached at Ana M. Echenique, MD, Sylvester Comprehensive Cancer Center, 1475 NW 12th Ave, 1st floor, Miami, FL 33136. Email: aecheniq@mac.com.

Suggested citation: Echenique AM. Palliation in interventional oncology: an update. Articles from the official show daily for Synergy 2016. Intervent Oncol 360. 2017;6(2):E20-E22.