Effect of Early Palliative Care on Quality of Life of Advanced Head and Neck Cancer Patients: A Phase III Trial

Background Early palliative care (EPC) is an important aspect of cancer management but has never been evaluated in patients with head and neck cancer. Hence, we performed this study to determine whether the addition of EPC to standard therapy leads to an improvement in the quality of life (QOL), decrease in symptom burden and improvement in overall survival. Methods Adult patients with squamous cell carcinoma of the head and neck region planned for palliative systemic therapy, were allocated 1:1 to either standard systemic therapy without (STD arm) or with comprehensive EPC service referral (EPC arm). Patients were administered the revised Edmonton Symptom Assessment Scale (ESAS-r) and the Functional Assessment of Cancer Therapy for head and neck cancer (FACIT HN) questionnaire at baseline and every 1 month thereafter for 3 months. The primary endpoint was a change in the QOL measured at 3 months after random assignment. All statistical tests were 2-sided. Results Ninety patients were randomly assigned to each arm. There was no statistical difference in the change in the FACT-H&N total score (P = .94), FACT-H&N Trial Outcome Index (P = .95), FACT- G (general) total (P = .84) and ESAS-r scores at 3 months between the two arms. The median overall survival was similar between the two arms (Hazard ratio for death = 1.01, 95% CI = 0.74–1.35). There were 5 in-hospital deaths in both arms (5.6% for both, P = .99). Conclusions In this phase III study, the integration of EPC in head and neck cancer patients did not lead to an improvement in the QOL or survival.