Early palliative care for improving quality of life and survival time in adults with advanced cancer

ObjectiveEarly palliative care (EPC) in the outpatient setting improves quality of life for patients with advanced cancer, but its impact on quality of dying and death (QODD) and on quality of life at the end of life (QOL-EOL) has not been examined. Our study investigated the impact of EPC on patients’ QODD and QOL-EOL and the moderating role of receiving inpatient or home palliative care.MethodBereaved family caregivers who had provided care for patients participating in a cluster-randomised trial of EPC completed a validated QODD scale and indicated whether patients had received additional home palliative care or care in an inpatient palliative care unit (PCU). We examined the effects of EPC, inpatient or home palliative care, and their interactions on the QODD total score and on QOL-EOL (last 7 days of life).ResultsA total of 157 caregivers participated. Receipt of EPC showed no association with QODD total score. However, when additional palliative care was included in the model, intervention patients demonstrated better QOL-EOL than controls (p=0.02). Further, the intervention by PCU interaction was significant (p=0.02): those receiving both EPC and palliative care in a PCU had better QOL-EOL than those receiving only palliative care in a PCU (mean difference=27.10, p=0.002) or only EPC (mean difference=20.59, p=0.02).ConclusionAlthough there was no association with QODD, EPC was associated with improved QOL-EOL, particularly for those who also received inpatient care in a PCU. This suggests a long-term benefit from early interdisciplinary palliative care on care throughout the illness.Trial registration numberClinicalTrials.gov Registry (#NCT01248624).

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Phase 2 trial of Symptom screening with Targeted Early Palliative care (STEP) for patients with advanced cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.11604 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. 11604-11604 ◽

Cited By ~ 1

Author(s):

Camilla Zimmermann ◽

Breffni Hannon ◽

Monika K. Krzyzanowska ◽

Madeline Li ◽

Gary Rodin ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Advanced Cancer ◽

Assessment System ◽

Phase 2 ◽

Clinical Prognosis ◽

Early Palliative Care ◽

Phase 2 Trial ◽

Symptom Screening

11604 Background: Routine early palliative care (EPC) by specialized teams improves quality of life for patients with advanced cancer, but may not be scalable. To plan for a larger randomized controlled trial, we conducted a phase 2 trial of STEP, a novel intervention of targeted EPC based on symptom screening. Methods: Participants with advanced cancer, ECOG 0-2, and clinical prognosis ≥6 months were recruited from lung, gastrointestinal, genitourinary, breast and gynecology outpatient clinics. Symptoms were screened at every outpatient visit using the Edmonton Symptom Assessment System-revised (ESAS-r). Moderate to severe symptom scores (≥4/10 for pain, nausea, dyspnea, depression, anxiety; ≥7/10 for fatigue, appetite, drowsiness, well-being) triggered an e-mail to a nurse, who called the patient, offering an EPC visit. Participants completed outcome measures at baseline, 2, 4 and 6 months (primary endpoint). Trial feasibility criteria were: i) ≥100 patients accrued in 12 months; ii) ≥70% complete screening for ≥70% of visits; iii) ≥60% of those for whom a call is triggered meet at least once with the EPC team; iv) ≥60% complete measures at each endpoint. Results: From 11/2016-1/2018, 116 patients were enrolled; 89/116 (77%) completed screening for ≥70% of visits and 59% (69/116) received a call triggered by symptoms. Of those receiving a call, 62% (43/69) received EPC; 3 further patients were referred by their oncologist. Measure completion was 79% (81/116) at 2, 61% (71/116) at 4, and 57% (66/116) at 6 months. By trial end (6 months), patients who received a call and accepted EPC involvement had better symptom control (ESAS-r-CS mean change in those receiving vs. deferring EPC: -0.07±16.9 vs 11.8±13.7, p = 0.02) and less deterioration in mood (PHQ-9: -0.4±3.4 vs 2.6±2.3, p = 0.003). There was no difference between those receiving versus deferring EPC in quality of life (FACIT-Sp: -4.7±13.6 vs -3.2±15.4, p = 0.75; QUAL-E: -2.6±8.4 vs -1.5±11.0, p = 0.62), or satisfaction with care (FAMCARE-P-16: -3.2±7.9 vs -3.5±6.1, p = 0.79). Conclusions: STEP is feasible in patients with advanced cancer. More than half of patients have moderate to severe symptoms, and acceptance of the triggered EPC visit should be encouraged.

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Single early palliative care intervention added to usual oncology care for patients with advanced cancer: A randomized controlled trial (SENS Trial)

Palliative Medicine ◽

10.1177/02692163211005340 ◽

2021 ◽

pp. 026921632110053

Author(s):

Steffen Eychmüller ◽

Susanne Zwahlen ◽

Monica C Fliedner ◽

Peter Jüni ◽

Daniel M Aebersold ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Advanced Cancer ◽

Health Related Quality ◽

Early Palliative Care ◽

Care Intervention ◽

Related Quality ◽

Health Related ◽

Oncology Care

Background: International oncology societies recommend early palliative care. Specific models to integrate early palliative care efficiently into clinical practice are debated. The authors designed a study to look at the quantitative and qualitative outcomes of an early palliative care intervention in oncological care to decrease stress and improve quality of life. Aims: To compare a single structured early palliative care intervention added to a usual oncology care in terms of distress and health-related quality of life at baseline compared to 6 months after enrollment. Design: This multicenter randomized controlled trial (NCT01983956) enrolled adult patients with advanced cancer. Participants were either randomly assigned to usual oncology care alone or usual care plus a structured early palliative care intervention. Setting/participants: One hundred fifty adult patients with a variety of advanced cancer diagnoses were randomized. Seventy-four participants were in the intervention and 76 participants in the control group. The primary outcome was the change in patient distress assessed by the National Comprehensive Cancer Network distress thermometer at 6 months. Health-related quality of life, the secondary outcome, was assessed by the Functional Assessment of Cancer Therapy–General Questionnaire. Results: The results showed no significant effect of the early palliative care intervention neither on patient distress nor on health-related quality of life. Conclusion: The addition of an early intervention to usual care for patients with advanced cancer did not improve distress or quality of life. Thus, patients may need more intensive early palliative care with continuous professional support to identify and address their palliative needs early.

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Early palliative care and quality of life of advanced cancer patients—a multicenter randomized clinical trial

Annals of Palliative Medicine ◽

10.21037/apm.2019.02.07 ◽

2019 ◽

Vol 8 (4) ◽

pp. 381-389 ◽

Cited By ~ 2

Author(s):

Vittorio Franciosi ◽

Giuseppe Maglietta ◽

Claudia Degli Esposti ◽

Giuseppe Caruso ◽

Luigi Cavanna ◽

...

Keyword(s):

Quality Of Life ◽

Clinical Trial ◽

Palliative Care ◽

Randomized Clinical Trial ◽

Cancer Patients ◽

Advanced Cancer ◽

Advanced Cancer Patients ◽

Early Palliative Care

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Caregiver quality of life in advanced cancer: Qualitative results from a trial of early palliative care

Palliative Medicine ◽

10.1177/0269216317739806 ◽

2017 ◽

Vol 32 (1) ◽

pp. 69-78 ◽

Cited By ~ 10

Author(s):

Julie McDonald ◽

Nadia Swami ◽

Ashley Pope ◽

Sarah Hales ◽

Rinat Nissim ◽

...

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Advanced Cancer ◽

Burden Of Illness ◽

Randomised Trial ◽

Intervention Group ◽

Cluster Randomised Trial ◽

Early Palliative Care ◽

Caregiver Quality

Background: Early involvement of palliative care improves patient quality of life; however, quantitative studies have not yet demonstrated a similar effect for caregivers, for whom the construct of quality of life is less well developed. Aim: To conceptualise quality of life of caregivers from their own perspective and to explore differences in themes between those who did or did not receive an early palliative care intervention. Design: Qualitative grounded theory study. Setting: Tertiary comprehensive cancer centre. Participants: Following participation in a cluster-randomised trial of early palliative care, 23 caregivers (14 intervention and 9 control) of patients with advanced cancer participated in semi-structured interviews to discuss their quality of life. Results: The core category was ‘living in the patient’s world’. Five related themes were ‘burden of illness and caregiving’, ‘assuming the caregiver role’, ‘renegotiating relationships’, ‘confronting mortality’ and ‘maintaining resilience’. There was thematic consistency between trial arms, except for the last two themes, which had distinct differences. Participants in the intervention group engaged in open discussion about the end of life, balanced hope with realism and had increased confidence from a range of professional supports. Controls tended to engage in ‘deliberate ignorance’ about the future, felt uncertain about how they would cope and lacked knowledge of available supports. Conclusions: Caregiver quality of life is influenced profoundly by the interaction with the patient and should be measured with specific questionnaires that include content related to confronting mortality and professional supports. This would improve delineation of quality of life for caregivers and allow greater sensitivity to change. Registration: clinicaltrials.gov NCT01248624

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Shifting Palliative Care Paradigm in Primary Care From Better Death to Better End-of-Life : A Swiss Pilot Study

10.21203/rs.3.rs-153919/v1 ◽

2021 ◽

Author(s):

Johanna Sommer ◽

Christopher Chung ◽

Dagmar M. Haller ◽

Sophie Pautex

Keyword(s):

Quality Of Life ◽

Primary Care ◽

Palliative Care ◽

Pilot Study ◽

End Of Life ◽

Cancer Patients ◽

Advanced Cancer ◽

Communication Skills ◽

Advanced Cancer Patients

Abstract Background: Patients suffering from advanced cancer often loose contact with their primary care physician (PCP) during oncologic treatment and palliative care is introduced very late.The aim of this pilot study was to test the feasibility and procedures for a randomized trial of an intervention to teach PCPs a palliative care approach and communication skills to improve advanced cancer patients’ quality of life. Methods: Observational pilot study in 5 steps. 1) Recruitment of PCPs. 2) Intervention: training on palliative care competencies and communication skills addressing end-of-life issues.3) Recruitment of advanced cancer patients by PCPs. 4) Patients follow-up by PCPs, and assessment of their quality of life by a research assistant 5) Feedback from PCPs using a semi-structured focus group and three individual interviews with qualitative deductive theme analysis.Results: 8 PCPs were trained. PCPs failed to recruit patients for fear of imposing additional loads on their patients. PCPs changed their approach of advanced cancer patients. They became more conscious of their role and responsibility during oncologic treatments and felt empowered to take a more active role picking up patient’s cues and addressing advance directives. They developed interprofessional collaborations for advance care planning. Overall, they discovered the role to help patients to make decisions for a better end-of-life.Conclusions: PCPs failed to recruit advanced cancer patients, but reported a change in paradigm about palliative care. They moved from a focus on helping patients to die better, to a new role helping patients to define the conditions for a better end-of-life.Trial registration : The ethics committee of the canton of Geneva approved the study (2018-00077 Pilot Study) in accordance with the Declaration of Helsinki

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