Dr. Holly G. Prigerson, the Irving Sherwood Wright Professor in Geriatrics and co-director of the Center for Research on End-of-Life Care at Weill Cornell Medicine, has been awarded a National Cancer Institute Outstanding Investigator Award to study psychosocial influences on, and outcomes of, end-stage cancer care.
Funded by the NIH, the award supports accomplished leaders in cancer research who are making significant contributions toward understanding cancer and developing applications that may lead to breakthroughs in biomedical, behavioral or clinical cancer research. The seven-year $7 million renewal grant will enable Dr. Prigerson to continue research she began in 2015, also with $7 million in funding from the NIH.
Despite great strides made in understanding and treating cancer, including immunotherapy, the number of cancer deaths remains on the rise, with cancer still the second leading cause of death in the United States. “Not only is the number of people dying of cancer increasing, but the quality of those deaths continues to be alarmingly poor,” said Dr. Prigerson, who is also a professor of sociology in medicine.
“Many cancer patients suffer severely as a result of poor clinical communication and lack of attention to their physical, psychological, social, existential and spiritual care needs, as well as those of their family caregivers.”
Cancer patients very near to death, unbeknownst to them, all too often receive highly toxic, burdensome anti-cancer treatments that are unlikely to prolong their life, noted Dr. Prigerson. And, as her data have shown, will likely impair their quality of life quite significantly.
“It seems unethical that patients are often neither made aware of nor given an opportunity to voice their concerns, express their wishes, and have their goals of care met in their final days,” she said. “Patients need to be informed of the benefits and harms of treatments offered to them so that they can better ensure that their care preferences and broader goals and values are respected.”
Family caregivers are also negatively affected by poor clinical communication. When their loved one’s prognosis isn’t clearly communicated, they are denied the information needed to make optimal decisions about the patient’s end-of-life care. “In bereavement, caregivers can be left with a sense of decisional regret about the choices that were or weren’t made for their dying family member,” Dr. Prigerson said.
To improve quality of life for advanced cancer patients and their caregivers, Dr. Prigerson has developed several behavioral and psychosocial interventions to promote better communication and decision-making, reduce racial and ethnic disparities in end-stage cancer care, and address psychosocial, existential and spiritual needs of dying cancer patients and their family members who survive them. These include simple tools oncologists can use to enable them to communicate end-stage prognoses to patients and their caregivers more effectively, and a program in which trained clinical staff meet with family surrogates of patients in the intensive care unit, to help them make better decisions for the patient who can no longer communicate, promote their receipt of higher quality end-stage cancer care, and assist with the psychosocial adjustment of bereaved family caregivers. During the next seven years of the study, Dr. Prigerson and her team will pilot these and other interventions.
“There are many psychosocial influences that dictate the choices made at the end of life and also a lot of unmet psychosocial and spiritual care needs,” Dr. Prigerson said. “Hopefully our approaches will help to ensure that dying cancer patients and their caregivers receive the highest quality of end-of-life cancer care possible.”