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

EPCISG group

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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 languageEnglish
Pages (from-to)110-118
Number of pages9
JournalEuropean Journal of Cancer
Volume69
DOIs
Publication statusPublished - Dec 1 2016

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Quality of Health Care
Palliative Care
Randomized Controlled Trials
Hospices
Therapeutics
Hospice Care
Drug Therapy
Standard of Care
Pancreatic Neoplasms
Neoplasms
Outpatients
Outcome Assessment (Health Care)
Costs and Cost Analysis
Survival

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

@article{26069389030243108aa13b51f97517b3,
title = "Systematic versus on-demand early palliative care: A randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life",
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).",
keywords = "Care aggressiveness near the end of life, Early palliative care, Use of health care services",
author = "Maltoni, {Marco Cesare} and Emanuela Scarpi and Monia Dall'Agata and Stefania Schiavon and Claudia Biasini and Carla Codec{\`a} and Broglia, {Chiara Maria Giovann} and E. Sansoni and Roberto Bortolussi and Ferdinando Garetto and Luisa Fioretto and Cattaneo, {M. T.} and Alice Giacobino and Massimo Luzzani and Giovanna Luchena and Sara Alquati and S. Quadrini and Vittorina Zagonel and Luigi Cavanna and Daris Ferrari and Paolo Pedrazzoli and Frassineti, {Giovanni Luca Paolo} and Antonella Galiano and {Casadei Gardini}, Andrea and Manlio Monti and Oriana Nanni and {EPCISG group}",
year = "2016",
month = "12",
day = "1",
doi = "10.1016/j.ejca.2016.10.004",
language = "English",
volume = "69",
pages = "110--118",
journal = "European Journal of Cancer",
issn = "0959-8049",
publisher = "Elsevier Ltd",

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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 Cesare

AU - Scarpi, Emanuela

AU - Dall'Agata, Monia

AU - Schiavon, Stefania

AU - Biasini, Claudia

AU - Codecà, Carla

AU - Broglia, Chiara Maria Giovann

AU - Sansoni, E.

AU - Bortolussi, Roberto

AU - Garetto, Ferdinando

AU - Fioretto, Luisa

AU - Cattaneo, M. T.

AU - Giacobino, Alice

AU - Luzzani, Massimo

AU - Luchena, Giovanna

AU - Alquati, Sara

AU - Quadrini, S.

AU - Zagonel, Vittorina

AU - Cavanna, Luigi

AU - Ferrari, Daris

AU - Pedrazzoli, Paolo

AU - Frassineti, Giovanni Luca Paolo

AU - Galiano, Antonella

AU - Casadei Gardini, Andrea

AU - Monti, Manlio

AU - Nanni, Oriana

AU - EPCISG group

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

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U2 - 10.1016/j.ejca.2016.10.004

DO - 10.1016/j.ejca.2016.10.004

M3 - Article

VL - 69

SP - 110

EP - 118

JO - European Journal of Cancer

JF - European Journal of Cancer

SN - 0959-8049

ER -