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).
| Original language | English |
|---|---|
| Pages (from-to) | 110-118 |
| Number of pages | 9 |
| Journal | European Journal of Cancer |
| Volume | 69 |
| DOIs | |
| Publication status | Published - Dec 1 2016 |
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Keywords
- Care aggressiveness near the end of life
- Early palliative care
- Use of health care services
ASJC Scopus subject areas
- Oncology
- Cancer Research
Cite this
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, Vol. 69, 01.12.2016, p. 110-118.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Systematic versus on-demand early palliative care
T2 - A randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life
AU - Maltoni, Marco
AU - Scarpi, Emanuela
AU - Dall'Agata, Monia
AU - Schiavon, Stefania
AU - Biasini, Claudia
AU - Codecà, Carla
AU - Broglia, Chiara Maria
AU - Sansoni, Elisabetta
AU - Bortolussi, Roberto
AU - Garetto, Ferdinando
AU - Fioretto, Luisa
AU - Cattaneo, Maria Teresa
AU - Giacobino, Alice
AU - Luzzani, Massimo
AU - Luchena, Giovanna
AU - Alquati, Sara
AU - Quadrini, Silvia
AU - Zagonel, Vittorina
AU - Cavanna, Luigi
AU - Ferrari, Daris
AU - Pedrazzoli, Paolo
AU - Frassineti, Giovanni Luca
AU - Galiano, Antonella
AU - Casadei Gardini, Andrea
AU - Monti, Manlio
AU - Nanni, Oriana
PY - 2016/12/1
Y1 - 2016/12/1
N2 - 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).
AB - 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).
KW - Care aggressiveness near the end of life
KW - Early palliative care
KW - Use of health care services
UR - http://www.scopus.com/inward/record.url?scp=84993999148&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84993999148&partnerID=8YFLogxK
U2 - 10.1016/j.ejca.2016.10.004
DO - 10.1016/j.ejca.2016.10.004
M3 - Article
AN - SCOPUS:84993999148
VL - 69
SP - 110
EP - 118
JO - European Journal of Cancer
JF - European Journal of Cancer
SN - 0959-8049
ER -