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

Marco Maltoni, Emanuela Scarpi, Monia Dall'Agata, Stefania Schiavon, Claudia Biasini, Carla Codecà, Chiara Maria Broglia, Elisabetta Sansoni, Roberto Bortolussi, Ferdinando Garetto, Luisa Fioretto, Maria Teresa Cattaneo, Alice Giacobino, Massimo Luzzani, Giovanna Luchena, Sara Alquati, Silvia Quadrini, Vittorina Zagonel, Luigi Cavanna, Daris FerrariPaolo Pedrazzoli, Giovanni Luca Frassineti, Antonella Galiano, Andrea Casadei Gardini, Manlio Monti, Oriana Nanni, Early Palliative Care Italian Study Group (EPCISG)

Research output: Contribution to journalArticle

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 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

  • Journal Article

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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. / 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; Early Palliative Care Italian Study Group (EPCISG).

In: European Journal of Cancer, Vol. 69, 12.2016, p. 110-118.

Research output: Contribution to journalArticle

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) 2016, 'Systematic versus on-demand early palliative care: A randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life', European Journal of Cancer, vol. 69, pp. 110-118. https://doi.org/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 ; Early Palliative Care Italian Study Group (EPCISG). / Systematic versus on-demand early palliative care : A randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life. In: European Journal of Cancer. 2016 ; Vol. 69. pp. 110-118.
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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

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

AU - Early Palliative Care Italian Study Group (EPCISG)

N1 - Copyright © 2016 Elsevier Ltd. All rights reserved.

PY - 2016/12

Y1 - 2016/12

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 - Journal Article

UR - https://www.ncbi.nlm.nih.gov/pubmed/27821313

U2 - 10.1016/j.ejca.2016.10.004

DO - 10.1016/j.ejca.2016.10.004

M3 - Article

C2 - 27821313

VL - 69

SP - 110

EP - 118

JO - European Journal of Cancer

JF - European Journal of Cancer

SN - 0959-8049

ER -