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Systematic Versus On-demand Early Palliative Care: A Randomised Clinical Trial Assessing Quality Of Care And Treatment Aggressiveness Near The End Of Life.
M. Maltoni, E. Scarpi, M. Dall'agata, S. Schiavon, C. Biasini, C. Codecà, C. Broglia, E. Sansoni, R. Bortolussi, F. Garetto, L. Fioretto, M. T. Cattaneo, Alice Giacobino, M. Luzzani, G. Luchena, S. Alquati, S. Quadrini, V. Zagonel, L. Cavanna, D. Ferrari, P. Pedrazzoli, G. Frassineti, A. Galiano, A. Casadei Gardini, M. Monti, O. Nanni
Published 2016 · Medicine
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AIM Early palliative care (EPC) in oncology has shown sparse evidence of a positive impact on patient outcomes, quality of care outcomes and costs. PATIENTS AND METHODS Data for this secondary analysis were taken from a trial of 207 outpatients with metastatic pancreatic cancer randomly assigned to receive standard cancer care plus on-demand EPC (standard arm) or standard cancer care plus systematic EPC (interventional arm). After 20 months' follow-up, 149 (80%) had died. Outcome measures were frequency, type and timing of chemotherapy administration, use of resources, place of death and overall survival. RESULTS Some indices of end-of-life (EoL) aggressiveness had a favourable impact from systematic EPC. Interventional arm patients showed higher use of hospice services: a significantly longer median and mean period of hospice care (P = 0.025 for both indexes) and a significantly higher median and mean number of hospice admissions (both P < 0.010). In the experimental arm, chemotherapy was performed in the last 30 days of life in a significantly inferior rate with respect to control arm: 18.7% versus 27.8% (adjusted P = 0.036). Other non-significant differences were seen in favour of experimental arm. CONCLUSIONS Systematic EPC showed a significant impact on some indicators of EoL treatment aggressiveness. These data, reinforced by multiple non-significant differences in most of the other items, suggest that quality of care is improved by this approach. This study is registered on ClinicalTrials.gov (NCT01996540).
This paper references
What Is the Evidence That Palliative Care Teams Improve Outcomes for Cancer Patients and Their Families?
I. Higginson (2010)
American society of clinical oncology statement: toward individualized care for patients with advanced cancer.
J. Peppercorn (2011)
Early integration of palliative care services with standard oncology care for patients with advanced cancer
J. Greer (2013)
Cancer treatment and survivorship statistics, 2016
K. Miller (2016)
Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care.
J. Temel (2011)
Does palliative care improve outcomes for patients with incurable illness? A review of the evidence.
A. El-Jawahri (2011)
Progress against GI cancer during the American Society of Clinical Oncology's first 50 years.
R. Mayer (2014)
Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008
J. Ferlay (2010)
Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer.
J. Greer (2012)
The Medical Oncologist's Role in Palliative Care: AIOM's Position
V. Zagonel (2009)
Palliative medicine and medical oncology.
M. Maltoni (2001)
Palliative care in the outpatient oncology setting: evaluation of a practical set of referral criteria.
P. Glare (2011)
A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses.
M. Davis (2015)
Global estimates of cancer prevalence for 27 sites in the adult population in 2008
F. Bray (2013)
End-of-life care for older patients with ovarian cancer is intensive despite high rates of hospice use.
A. Wright (2014)
Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial.
Marie Bakitas (2015)
Effectiveness of specialized palliative care: a systematic review.
C. Zimmermann (2008)
Early specialty palliative care--translating data in oncology into practice.
Ravi B Parikh (2013)
Aggressiveness of cancer care near the end of life: is it a quality-of-care issue?
C. Earle (2008)
Cancer incidence and mortality patterns in Europe: estimates for 40 countries in 2012.
J. Ferlay (2013)
Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial
C. Zimmermann (2014)
Comparison of Early Versus Late Palliative Care Consultation in End-of-Life Care for the Hospitalized Frail Elderly Patients
C. Reyes-Ortiz (2015)
Early implementation of palliative care can improve patient outcomes.
P. Glare (2013)
Cancer treatment and survivorship statistics, 2014
Carol E DeSantis (2014)
Systematic versus on-demand early palliative care: results from a multicentre, randomised clinical trial.
M. Maltoni (2016)
Top 10 things palliative care clinicians wished everyone knew about palliative care.
J. Strand (2013)
The project ENABLE II randomized controlled trial to improve palliative care for rural patients with advanced cancer: baseline findings, methodological challenges, and solutions.
Marie Bakitas (2009)
Early palliative care for patients with metastatic non-small-cell lung cancer.
J. Temel (2010)
European Society for Medical Oncology (ESMO) Program for the integration of oncology and Palliative Care: a 5-year review of the Designated Centers' incentive program.
N. Cherny (2010)
Integration of oncology and palliative care: a systematic review.
D. Hui (2015)
Palliative care and the aggressiveness of end-of-life care in patients with advanced pancreatic cancer.
R. W. Jang (2015)
Change in end-of-life care for Medicare beneficiaries: site of death, place of care, and health care transitions in 2000, 2005, and 2009.
J. Teno (2013)
Recommending early integration of palliative care — does it work?
J. Gaertner (2011)
American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care.
T. Smith (2012)
Integrating supportive and palliative care in the trajectory of cancer: establishing goals and models of care.
E. Bruera (2010)
This paper is referenced by
The effect of early and systematic integration of palliative care in oncology on quality of life and health care use near the end of life: A randomised controlled trial.
Gaëlle Vanbutsele (2019)
Palliative Care and Cancer
K. Pardon (2018)
Multicentre analysis of intensity of care at the end-of-life in patients with advanced cancer, combining health administrative data with hospital records: variations in practice call for routine quality evaluation
I. Colombet (2019)
Causes of Hospital Admissions in Domus: A Randomized Controlled Trial of Specialized Palliative Cancer Care at Home.
Kirstine Skov Benthien (2018)
Systematic vs. on-demand early palliative care in gastric cancer patients: a randomized clinical trial assessing patient and healthcare service outcomes
E. Scarpi (2018)
Is early integration of palliative care feasible and acceptable for advanced respiratory and gastrointestinal cancer patients? A phase 2 mixed-methods study
M. Costantini (2018)
Early palliative care versus standard care in haematologic cancer patients at their last active treatment: study protocol of a feasibility trial
S. Tanzi (2020)
The importance of quality-of-life management in patients with advanced pancreatic ductal adenocarcinoma.
A. Lewis (2018)
Integration of oncology and palliative care: a Lancet Oncology Commission.
S. Kaasa (2018)
Utilization of Hospice Care in Patients With Acute Ischemic Stroke
N. Chauhan (2019)
High‐intensity end‐of‐life care among children, adolescents, and young adults with cancer who die in the hospital: A population‐based study from the French national hospital database
Gabriel Revon-Rivière (2019)
Outpatient palliative care and thoracic medical oncology: Referral criteria and clinical care pathways.
A. Caraceni (2019)
Improving patient and caregiver outcomes in oncology: Team‐based, timely, and targeted palliative care
D. Hui (2018)
Acceptability of the MD Anderson Symptom Inventory and qualitative analysis of barriers to palliative care services for rural and non-rural populations
Daniel W. Johnson (2017)
Impact of palliative care on quality of end-of-life care among Brazilian patients with advanced cancers.
Talita Caroline de Oliveira Valentino (2019)
Community-based specialist palliative care is associated with reduced hospital costs for people with non-cancer conditions during the last year of life
K. Spilsbury (2017)
Development of a screening tool to improve the referral of patients with breast and gynecological cancer to outpatient palliative care.
C. Paiva (2020)
Transfusion dependence, use of hospice services, and quality of end-of-life care in leukemia.
T. Leblanc (2018)
Prevalence of Chronic Cancer and No-Cancer Pain in Elderly Hospitalized Patients: Elements for the Early Assessment of Palliative Care Needs
B. Maltoni (2018)
Improving patient outcomes through palliative care integration in other specialised health services: what we have learned so far and how can we improve?
D. Oliver (2018)
Pancreatic cancer: Best supportive care.
Anne-Laure Védié (2019)
Early palliative care for adults with advanced cancer.
M. Haun (2017)
Étude rétrospective monocentrique sur l'association entre les critères d'agressivité des soins en fin de vie et le suivi par une équipe de soins palliatifs chez les patients atteints de cancer en 2015
Pierre-Antoine Monier (2017)
Triggered Palliative Care Consults: A Systematic Review of Interventions for Hospitalized and Emergency Department Patients.
Emmett A Kistler (2020)
Palliative care and advance care planning for pancreas and other cancers.
R. Agarwal (2017)
The challenge of prognostication in palliative radiotherapy: the way forward is shared decision-making
R. Rossi (2019)
Nutritional support in cancer patients: reply to Scarpi et al
P. Pedrazzoli (2019)
Position Paper of the Italian Association of Medical Oncology on Early Palliative Care in Oncology Practice (Simultaneous Care)
V. Zagonel (2017)
La réunion de concertation pluridisciplinaire onco-palliative : objectifs et préconisations pratiques
F. Goldwasser (2018)
Potentially Avoidable Surgical Intensive Care Unit Admissions and Disposition Delays
Navpreet K Dhillon (2017)
Re‐inventing the randomized controlled trial in medical oncology: The registry‐based trial
S. Foroughi (2018)
Early versus delayed palliative/supportive care in advanced cancer: an observational study
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