The Impact of Palliative Care Dose Intensity on Outcomes for Patients with Cancer

Sedhom, Ramy; Gupta, Arjun; MacNabb, Lindsey; Smith, Thomas J.

doi:10.1634/theoncologist.2020-0551

Cited by 16 publications

(11 citation statements)

References 34 publications

(39 reference statements)

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“…Also, there appears to be a dose-response aspect to PC for pancreas cancer patients; the earlier and more frequent the PC visits, the less hospitalization and aggressive care at the end of life. 18 , 19 …”

Section: Discussionmentioning

confidence: 99%

Improving Palliative Care and Quality of Life in Pancreatic Cancer Patients

Chung

Sun

Ruel

et al. 2022

Journal of Palliative Medicine

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Background: Pancreatic cancer patients often present with complications, which can impact treatment tolerance. Thus, symptom management is a vital component of treatment in addition to traditional chemotherapeutics. Concurrent palliative care with an emphasis on aggressive symptom management may sustain both clinical and patient-centered outcomes during treatment. The purpose of this article is to explore the impact of a concurrent palliative care intervention in patients with pancreatic cancer treated on phase I clinical trials. Materials and Methods: This is a secondary analysis of a National Cancer Institute (NCI)-funded randomized trial of an advanced practice nurse driven palliative care intervention for solid tumor patients treated on phase I clinical trials. Only pancreatic cancer patients were included in the analysis. Patients received two educational sessions around the quality of life (QOL) domains and completed the Functional Assessment of Cancer Therapy—General (FACT-G), patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE), and the psychological distress thermometer at baseline, 4 and 12 weeks. Mixed model with repeated measures analysis was used to explore outcomes by study arm. Results: Of the 479 patients accrued to the study, 42 were diagnosed with pancreatic cancer (26 intervention, 16 usual care). A trend toward improvement in the physical, social, emotional, and functional FACT-G QOL subscales and psychological distress (baseline to 12 weeks) were observed for the intervention arm. Patients reported moderate severity in psychological and physical stress. Conclusions: In this secondary analysis, a nurse-led palliative care intervention may improve the QOL and psychological distress of pancreatic cancer patients. A phase III trial focused on patients with pancreatic cancer is needed to determine the effectiveness of the intervention.

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Section: Discussionmentioning

confidence: 99%

Improving Palliative Care and Quality of Life in Pancreatic Cancer Patients

Chung

Sun

Ruel

et al. 2022

Journal of Palliative Medicine

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“…The effects of an intervention can be variable if a single provider has a particularly effective (or ineffective) delivery. Second, these studies may not have delivered an appropriate dose intensity for the intervention to improve outcomes and more interactions over a longer period may be required 54. Third, in several studies, the nurses/APPs/SWs had also clinical roles and they could have had time constrains in delivering the intervention.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of models of palliative care delivered beyond the traditional physician-led, subspecialty consultation service model: a systematic review and meta-analysis

Stefan

Knee

Ready

et al. 2022

BMJ Support Palliat Care

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ObjectiveThis meta-analysis aimed to determine the effectiveness of non-physician provider-led palliative care (PC) interventions in the management of adults with advanced illnesses on patient-reported outcomes and advance care planning (ACP).MethodsWe included randomised trials and cluster trials published in MEDLINE, EMBASE, CINAHL, PsycINFO, Cochrane Register of Controlled Trials and ClinicalTrials.gov searched until July 2021 that examined individuals ≥18 years with a diagnosis of advanced, life-limiting illness and received a PC intervention led by a non-physician (nurse, advance practitioner or social worker). Our primary outcome was quality of life (QOL), which was extracted as unadjusted or adjusted estimates and measures of variability. Secondary outcomes included anxiety, depression and ACP.ResultsAmong the 21 studies (2370 subjects), 13 included patients with cancer, 3 with heart failure, 4 with chronic respiratory disease and 1 with chronic kidney disease. The interventions were diverse and varied with respect to team composition and services offered. For QOL, the standardised mean differences suggested null effects of PC interventions compared with usual care at 1–2 months (0.04; 95% CI=−0.14 to 0.23, n=10 randomised controlled trials (RCTs)) and 6–7 months (0.10; 95% CI=−0.15 to 0.34, n=6 RCTs). The results for anxiety and depression were not significant also. For the ACP, there was a strong benefit for the PC intervention (absolute increase of 0.32% (95% CI=0.06 to 0.57).ConclusionsIn this meta-analysis, PC interventions delivered by non-physician were not associated with improvement in QOL, anxiety or depression but demonstrated an impact on the ACP discussion and documentation.

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“…Similar to the phase I community, palliative care is also dynamic and evolving. 38 There is an increasing emphasis on palliative care supporting patients' goals and quality of life 39,40 and less focus on achieving a "good" death. The most important implication for phase I trialists is that contemporary palliative care teams may be good partners in early-phase trials for patients with advanced disease.…”

Section: Discussionmentioning

confidence: 99%

End-of-Life Characteristics Associated With Short Hospice Length of Stay for Patients With Solid Tumors Enrolled in Phase I Clinical Trials

Sedhom

Blackford

Gupta

et al. 2021

Journal of the National Comprehensive Cancer Network

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Background: Patients participating in phase I trials represent a population with advanced cancer and symptoms, with quality-of-life implications arising from both disease and treatment. Transitions to end-of-life care for these patients have received little attention. Good empirical data are needed to better understand the role of advance care planning and palliative care during phase I trial transitions. We investigated how physician–patient communication at the time of disease progression, patient characteristics, and patterns of care were associated with end-of-life care. Methods: We conducted a retrospective chart review of all patients with solid tumors enrolled in phase I trials at a comprehensive cancer center from January 2015 to December 2017. We captured physician–patient communication during disease progression. Among patients who died, we assessed palliative care referral, advance care planning, place of death, healthcare use in the final month of life, hospice enrollment, and hospice length of stay (LOS). Factors independently associated with a short hospice LOS (defined as ≤3 days) were estimated from a multivariable model building approach. Results: Among 207 participants enrolled in phase I intervention studies at Johns Hopkins Hospital, the median age was 61 years (range, 31–91 years), 48% were women, 21% were members of racial minority groups, and 41.5% were referred from an outside institution. At the time of disease progression, 53% had goals of care documented, 47% were previously referred to palliative care, and 41% discussed hospice with their oncologist. A total of 82% of decedents died within 1 year of study enrollment, and 85% enrolled in hospice. Among the 147 participants who enrolled in hospice, 22 (15%) had a short LOS (≤3 days). Factors independently associated with an increased risk of short hospice LOS in the multivariable model included age >65 years (odds ratio [OR], 1.12; 95% CI, 1.01–1.24; P=.04), whereas remaining at the same institution (OR, 0.72; 95% CI, 0.65–0.80; P<.001) and referral to palliative care before progression (OR, 0.83; 95% CI, 0.75–0.92; P<.001) were associated with a decreased risk of short hospice LOS. Conclusions: Reported data support the benefit of palliative care for patients in phase I trials and the risks associated with healthcare transitions for all patients, particularly older adults, regardless of care received. Leaving a clinical trial is a time when clear communication is paramount. Phase I studies will continue to be vital in advancing cancer treatment. It is equally important to advance the support provided to patients who transition off these trials.

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The Impact of Palliative Care Dose Intensity on Outcomes for Patients with Cancer

Abstract: This commentary discusses evidence supporting the importance of full palliative care dose intensity in outcomes for patients with cancer.

Cited by 16 publications

References 34 publications

Improving Palliative Care and Quality of Life in Pancreatic Cancer Patients

Improving Palliative Care and Quality of Life in Pancreatic Cancer Patients

Efficacy of models of palliative care delivered beyond the traditional physician-led, subspecialty consultation service model: a systematic review and meta-analysis

End-of-Life Characteristics Associated With Short Hospice Length of Stay for Patients With Solid Tumors Enrolled in Phase I Clinical Trials

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