Systematic versus on-demand early palliative care; A randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life
Articolo
Data di Pubblicazione:
2016
Abstract:
Abstract
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).
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).
Tipologia CRIS:
1.1 Articolo in rivista
Keywords:
Care aggressiveness near the end of life; Early palliative care; Use of health care services
Elenco autori:
Maltoni, M.; Scarpi, E.; Dall'Agata, M.; Schiavon, S.; Biasini, C.; Codecà, C.; Broglia, Cm.; Sansoni, E.; Bortolussi, R.; Garetto, F.; Fioretto, L.; Cattaneo, Mt.; Giacobino, A.; Luzzani, M.; Luchena, G.; Alquati, S.; Quadrini, S.; Zagonel, V.; Cavanna, L.; Ferrari, D.; Pedrazzoli, P.; Frassineti, Gl.; Galiano, A.; Casadei Gardini, A.; Monti, M.; Nanni, O; Early Palliative Care Italian Study Group, (EPCISG)
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