Early palliative care versus standard care in haematologic cancer patients at their last active treatment: study protocol of a feasibility trial

Abstract

Background: Patients with advanced haematological malignancies suffer from a very high symptom burden and psychological, spiritual, social and physical symptoms comparable with patients with metastatic non-haematological malignancy. Referral to palliative care services for these patients remains limited or often confined to the last days of life. We developed a palliative care intervention (PCI) integrated with standard haematological care. The aim of the study was focussed on exploring the feasibility of the intervention by patients, professionals and caregivers and on assessing its preliminary efficacy. Methods/design. This is a mixed-methods phase 2 trial. The Specialist Palliative Care Team (SPCT) will follow each patient on a monthly basis in the outpatient clinic or will provide consultations during any hospital admission. SPCT and haematologists will discuss active patient issues to assure a team approach to the patient's care. This quantitative study is a monocentric parallel-group superiority trial with balanced randomisation comparing the experimental PCI plus haematological standard care versus haematological standard care alone. The primary endpoint will calculate on adherence to the planned PCI, measured as the percentage of patients randomised to the experimental arm who attend all the planned palliative care visits in the 24 weeks after randomisation. The qualitative study follows the methodological indications of concurrent nested design and was aimed at exploring the acceptability of the PCI from the point of view of patients, caregivers and physicians.(Continued on next page)

Lesson Learned From Hospital Palliative Care Service in a Cancer Research Center in Italy: Results of 5 Years of Experience

“…Outpatient days in charge from 2015 to 2019 show an increasing rate with an average of patients in charge of more than 2 months. These results, in our opinion, could be related to a better knowledge of the PC Service by other professionals and a positive secondary outcome of the development of specific research projects (24,29,33).…”

“…Since 2015, PCS has provided training to health professionals (HPs) of different departments of our hospital. Most of the educational projects for HPs were part of research projects, for example the communication training program performed for the Medical Oncology and Hematology Departments ( 33 ), projects carried out to improve the management of pain and end-of-life symptoms ( 31 ), and the training program, for PC-based skills for HPs from the Radiotherapy, Geriatrics and Nephrology/Dialysis wards ( 29 ).…”

Impact of Early Palliative Care to Improve Quality of Life of Advanced Cancer Patients: A Meta-Analysis of Randomised Controlled Trials

“…[5][6][7] Some studies show that EPC is recommended, because it can affect the quality of life (QoL) compared to standard cancer care among patients with advanced cancer specifically for patients with solid tumours. [8][9][10] EPC is possible to affect the psychological, physical symptoms, proper relationships, effective communication and support in decision-making.…”

Identification of Psychological and Social Problems in Caregivers of Individuals Diagnosed with Hematologic Malignancy

“…Patients with advanced hematologic cancer face more psychological, mental, social, and physical problems, as well as fatigue, pain, and roles they experience compared to patients without metastatic cancer. [ 4 5 ] In addition, more prevalent symptoms are observed in this group as more aggressive treatment and more chemotherapy or biological agents are used compared to patients with solid tumors. [ 5 ] It is stated that these symptoms in hematologic cancer studies have increased the need for care,[ 2 ] and there is a need for different levels of care in relation to the severity, subgroup, type, and treatment side effects of the disease.…”

“…[ 4 5 ] In addition, more prevalent symptoms are observed in this group as more aggressive treatment and more chemotherapy or biological agents are used compared to patients with solid tumors. [ 5 ] It is stated that these symptoms in hematologic cancer studies have increased the need for care,[ 2 ] and there is a need for different levels of care in relation to the severity, subgroup, type, and treatment side effects of the disease. [ 6 ] In the systematic review of Moghaddam et al , the needs of care that were least addressed in the cancer patients were the informative approach (30%–55%) as well as psychological (18%–42%), physical (17%–48%), and functional fields (17%–37%).…”