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).

Systematic versus on-demand early palliative care: A randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life / Maltoni, Marco; Scarpi, Emanuela; Dall'Agata, Monia; Schiavon, Stefania; Biasini, Claudia; Codecà, Carla; Broglia, Chiara Maria; Sansoni, Elisabetta; Bortolussi, Roberto; Garetto, Ferdinando; Fioretto, Luisa; Cattaneo, Maria Teresa; Giacobino, Alice; Luzzani, Massimo; Luchena, Giovanna; Alquati, Sara; Quadrini, Silvia; Zagonel, Vittorina; Cavanna, Luigi; Ferrari, Daris; Pedrazzoli, Paolo; Frassineti, Giovanni Luca; Galiano, Antonella; Casadei Gardini, Andrea; Monti, Manlio; Nanni, Oriana. - In: EUROPEAN JOURNAL OF CANCER. - ISSN 1879-0852. - 69:(2016), pp. 110-118. [10.1016/j.ejca.2016.10.004]

Systematic versus on-demand early palliative care: A randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life

Casadei Gardini, Andrea;
2016

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).
2016
4-nov-2016
69
110
118
Systematic versus on-demand early palliative care: A randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life / Maltoni, Marco; Scarpi, Emanuela; Dall'Agata, Monia; Schiavon, Stefania; Biasini, Claudia; Codecà, Carla; Broglia, Chiara Maria; Sansoni, Elisabetta; Bortolussi, Roberto; Garetto, Ferdinando; Fioretto, Luisa; Cattaneo, Maria Teresa; Giacobino, Alice; Luzzani, Massimo; Luchena, Giovanna; Alquati, Sara; Quadrini, Silvia; Zagonel, Vittorina; Cavanna, Luigi; Ferrari, Daris; Pedrazzoli, Paolo; Frassineti, Giovanni Luca; Galiano, Antonella; Casadei Gardini, Andrea; Monti, Manlio; Nanni, Oriana. - In: EUROPEAN JOURNAL OF CANCER. - ISSN 1879-0852. - 69:(2016), pp. 110-118. [10.1016/j.ejca.2016.10.004]
Maltoni, Marco; Scarpi, Emanuela; Dall'Agata, Monia; Schiavon, Stefania; Biasini, Claudia; Codecà, Carla; Broglia, Chiara Maria; Sansoni, Elisabetta; Bortolussi, Roberto; Garetto, Ferdinando; Fioretto, Luisa; Cattaneo, Maria Teresa; Giacobino, Alice; Luzzani, Massimo; Luchena, Giovanna; Alquati, Sara; Quadrini, Silvia; Zagonel, Vittorina; Cavanna, Luigi; Ferrari, Daris; Pedrazzoli, Paolo; Frassineti, Giovanni Luca; Galiano, Antonella; Casadei Gardini, Andrea; Monti, Manlio; Nanni, Oriana
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