The effect of weekly specialist palliative care teleconsultations in patients with advanced cancer –a randomized clinical trial

LBA9513 Background: Family caregivers of individuals with advanced cancer experience significant burden and diminished QOL; few interventions have been found to reduce these outcomes. Methods: Randomized clinical trial conducted from 10/11/2010 to 9/5/2013 of immediate versus delayed (initiated 12 weeks after randomization) entry patients (n=207) and caregivers (n=122) into ENABLE (Educate, Nurture, Advise, Before Life Ends), a phone-based concurrent oncology palliative care intervention. QOL (Caregiver Quality of Life-Cancer, lower scores=better QOL), depression (Center for Epidemiological Study-Depression) and burden (Montgomery Borgatta Caregiver Burden Scale; subjective burden [SB], objective burden [OB]; demand burden [DB]) measures were collected at baseline, 6, 12, 18, and 24 weeks, and every 12 weeks until patient death or study completion. Results: Estimated treatment effects (immediate minus delayed) for caregivers from randomization to 12 weeks were (mean [SE]): -3.1 [2.3] for QOL (P=.17), -4.1 [1.3] for depression (P=.003), -1.0 [0.4] for SB (P=.02), 0.3 [0.6] for OB (P=.60), and -0.5 [0.6] for DB (P=.39). Estimated treatment effects (immediate minus delayed) from intervention initiation to 12 weeks were (mean [SE]): -6.4 [3.4] for QOL (P=.06), -7.4 [2] for depression (P<.001), -1.0 [0.6] for SB (P=.08), -0.6 [0.7] for OB (P=.44), and -0.5 [0.8] for DB (P=.50). Estimated treatment effects (immediate minus delayed) measured backwards from the time of patient’s death were (mean [SE]): of -4.9 [2.6] for QOL (P=.07), -3.8 [1.5] for depression (P=.02), -1.1 [0.4] for SB (P=.01), -0.6 [0.6] for OB (P=.26), and -0.7 [0.6] for DB (P=.22). Conclusions: Caregivers in the immediate group had lower depression, SB, and trends towards better QOL in comparisons up to 12 weeks, following initiation of the intervention in both groups, and in the terminal decline analysis. These results suggest that concurrent oncology palliative care should be initiated as early as possible to maximize benefit to caregivers. Clinical trial information: NCT01245621.

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Randomised clinical trial of early specialist palliative care plus standard care versus standard care alone in patients with advanced cancer: The Danish Palliative Care Trial

Palliative Medicine ◽

10.1177/0269216317705100 ◽

2017 ◽

Vol 31 (9) ◽

pp. 814-824 ◽

Cited By ~ 29

Author(s):

Mogens Groenvold ◽

Morten Aagaard Petersen ◽

Anette Damkier ◽

Mette Asbjoern Neergaard ◽

Jan Bjoern Nielsen ◽

...

Keyword(s):

Clinical Trial ◽

Palliative Care ◽

Advanced Cancer ◽

Standard Care ◽

Primary Outcome ◽

Randomised Clinical Trial ◽

Sensitivity Analyses ◽

Specialist Palliative Care ◽

Beneficial Effects ◽

Secondary Outcomes

Background: Beneficial effects of early palliative care have been found in advanced cancer, but the evidence is not unequivocal. Aim: To investigate the effect of early specialist palliative care among advanced cancer patients identified in oncology departments. Setting/participants: The Danish Palliative Care Trial (DanPaCT) (ClinicalTrials.gov NCT01348048) is a multicentre randomised clinical trial comparing early referral to a specialist palliative care team plus standard care versus standard care alone. The planned sample size was 300. At five oncology departments, consecutive patients with advanced cancer were screened for palliative needs. Patients with scores exceeding a predefined threshold for problems with physical, emotional or role function, or nausea/vomiting, pain, dyspnoea or lack of appetite according to the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were eligible. The primary outcome was the change in each patient’s primary need (the most severe of the seven QLQ-C30 scales) at 3- and 8-week follow-up (0–100 scale). Five sensitivity analyses were conducted. Secondary outcomes were change in the seven QLQ-C30 scales and survival. Results: Totally 145 patients were randomised to early specialist palliative care versus 152 to standard care. Early specialist palliative care showed no effect on the primary outcome of change in primary need (−4.9 points (95% confidence interval −11.3 to +1.5 points); p = 0.14). The sensitivity analyses showed similar results. Analyses of the secondary outcomes, including survival, also showed no differences, maybe with the exception of nausea/vomiting where early specialist palliative care might have had a beneficial effect. Conclusion: We did not observe beneficial or harmful effects of early specialist palliative care, but important beneficial effects cannot be excluded.

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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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3-STEPS: A Study of an Individual Physical Activity Intervention in Advanced Cancer Patients on a Specialist Palliative Care Ward

10.26226/morressier.5c76c8bae2ea5a7237612475 ◽

2019 ◽

Author(s):

David Blum

Keyword(s):

Physical Activity ◽

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Physical Activity Intervention ◽

Specialist Palliative Care ◽

Advanced Cancer Patients ◽

Care Ward

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Faculty Opinions recommendation of Efficacy of oral risperidone, haloperidol, or placebo for symptoms of delirium among patients in palliative care: A randomized clinical trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.727072391.793527746 ◽

2017 ◽

Author(s):

Andrea Pace ◽

Veronica Villani

Keyword(s):

Clinical Trial ◽

Palliative Care ◽

Randomized Clinical Trial ◽

Oral Risperidone

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Social disparities and symptom burden in populations with advanced cancer: specialist palliative care providers’ perspectives

Supportive Care in Cancer ◽

10.1007/s00520-019-04726-z ◽

2019 ◽

Vol 27 (12) ◽

pp. 4733-4744 ◽

Cited By ~ 1

Author(s):

Anna Santos Salas ◽

Sharon M. Watanabe ◽

Yoko Tarumi ◽

Tracy Wildeman ◽

Ana M. Hermosa García ◽

...

Keyword(s):

Palliative Care ◽

Advanced Cancer ◽

Symptom Burden ◽

Social Disparities ◽

Care Providers ◽

Specialist Palliative Care ◽

Cancer Specialist

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Does acupressure help reduce nausea and vomiting in palliative care patients? A double blind randomised controlled trial

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2020-002434 ◽

2020 ◽

pp. bmjspcare-2020-002434

Author(s):

Paul Perkins ◽

Anne Parkinson ◽

Rebecca Parker ◽

Alison Blaken ◽

Ralph K Akyea

Keyword(s):

Palliative Care ◽

Randomised Controlled Trial ◽

Advanced Cancer ◽

Controlled Trial ◽

Acupuncture Point ◽

Nausea And Vomiting ◽

Specialist Palliative Care ◽

Double Blind ◽

Anticancer Treatment ◽

Randomised Controlled

IntroductionNausea and vomiting are common symptoms for patients with advanced cancer. While there is evidence for acupuncture point stimulation for treatment of these symptoms for patients having anticancer treatment, there is little for when they are not related to such treatment.ObjectiveTo determine whether acupressure at the pericardium 6 site can help in the treatment of nausea and vomiting suffered by palliative care patients with advanced cancer.Materials and methodsDouble blind randomised controlled trial—active versus placebo acupressure wristbands. In-patients with advanced cancer in two specialist palliative care units who fitted either or both of the following criteria were approached: Nausea that was at least moderate; Vomiting daily on average for the prior 3 days.Results57 patients were randomised to have either active or placebo acupressure wristbands. There was no difference in any of the outcome measures between the two groups: change from baseline number of vomits; Visual Analogue Scale for ‘did acupressure wristbands help you to feel better?’; total number of as needed doses of antiemetic medication; need for escalation of antiemetics.ConclusionsIn contrast to a previously published feasibility study, active acupressure wristbands were no better than placebo for specialist palliative care in-patients with advanced cancer and nausea and vomiting.

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