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Randomized trial of early integrated palliative and oncology care.
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2016
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Quality Of LifeCancer ManagementEarly Palliative CareGynecology OncologyOncologyEnd-of-life CarePatient-reported OutcomeGi CancerRadiation OncologyCancer ResearchHealth SciencesEarly PcOutcomes ResearchCancer PrognosisOncology CareLung CancerHospicePalliative CareTerminal IllnessMedicine
10003 Background: Early palliative care (PC) improves outcomes in patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC) and in patients identified by clinicians as having poor prognosis, advanced cancer. We evaluated the impact of early, integrated palliative and oncology care in patients with newly diagnosed lung and gastrointestinal (GI) cancer. Methods: We randomly assigned patients with newly diagnosed incurable lung (NSCLC, small cell, mesothelioma) or GI (pancreas, hepatobiliary, gastric, esophageal) cancer to PC integrated with oncology care (at least monthly visits with PC) or usual oncology care. We used the Functional Assessment of Cancer Therapy-General (FACT-G) to assess quality of life (QOL) and the Patient Health Questionniare-9 (PHQ-9) and Hospital Anxiety and Depression Scale (HADS) for mood at baseline, weeks 12 and 24. We assessed patients’ perception of their likelihood of cure and their communication about their end of life (EOL) preferences. WΒe used linear regression controlling for baseline values and clinical characteristics to evaluate the impact of group assignment on QOL and mood and chi-square to evaluate report of treatment intent and communication about EOL. Results: Between 5/2/11 and 7/20/15, we randomized 350 patients (175 per group), including 191 lung and 159 GI cancer patients. Patients assigned to early PC had higher QOL (β=4.98, 95%CI: 1.58 to 8.38, p=0.004) and less depression on the PHQ-9 (β=-1.22, 95% CI: -2.40 to -0.02, p=0.047) at 24 weeks, but not at 12 weeks. There were no between-group differences in HADS at either time point. At 24 weeks, similar proportions of patients reported that their cancer was unlikely to be cured (36/105 [33.6%] in PC and 43/115 [37.4%] in usual care) but more patients assigned to early PC reported they discussed their EOL preferences (31/116 [30.2%] versus 71/117 [14.5%], p=0.005). Patterns of change in QOL over time differed between lung and GI patients. Conclusions: Early PC improved QOL, decreased depression, and increased the frequency of EOL discussions in patients with newly diagnosed lung and GI cancer. The benefits of the integrated care model extend to other populations with newly diagnosed disease and include improved communication about EOL care. Clinical trial information: NCT01401907.