Abstract
Background: Beneficial effects of early palliative care have been found in advanced cancer, but the evidence is not unequivocal.
Aim: To investigate the effect of early specialist palliative care among advanced cancer patients identified in oncology departments.
Setting/participants: The Danish Palliative Care Trial (DanPaCT) (ClinicalTrials.gov NCT01348048) is a multicentre randomised clinical trial comparing early referral to a specialist palliative care team plus standard care versus standard care alone. The planned sample size was 300. At five oncology departments, consecutive patients with advanced cancer were screened for palliative needs. Patients with scores exceeding a predefined threshold for problems with physical, emotional or role function, or nausea/vomiting, pain, dyspnoea or lack of appetite according to the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were eligible. The primary outcome was the change in each patient’s primary need (the most severe of the seven QLQ-C30 scales) at 3- and 8-week follow-up (0–100 scale). Five sensitivity analyses were conducted. Secondary
outcomes were change in the seven QLQ-C30 scales and survival.
Results: Totally 145 patients were randomised to early specialist palliative care versus 152 to standard care. Early specialist palliative care showed no effect on the primary outcome of change in primary need (−4.9 points (95% confidence interval −11.3 to +1.5 points); p = 0.14). The sensitivity analyses showed similar results. Analyses of the secondary outcomes, including survival, also showed no
differences, maybe with the exception of nausea/vomiting where early specialist palliative care might have had a beneficial effect.
Conclusion: We did not observe beneficial or harmful effects of early specialist palliative care, but important beneficial effects cannot
be excluded.
Aim: To investigate the effect of early specialist palliative care among advanced cancer patients identified in oncology departments.
Setting/participants: The Danish Palliative Care Trial (DanPaCT) (ClinicalTrials.gov NCT01348048) is a multicentre randomised clinical trial comparing early referral to a specialist palliative care team plus standard care versus standard care alone. The planned sample size was 300. At five oncology departments, consecutive patients with advanced cancer were screened for palliative needs. Patients with scores exceeding a predefined threshold for problems with physical, emotional or role function, or nausea/vomiting, pain, dyspnoea or lack of appetite according to the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) were eligible. The primary outcome was the change in each patient’s primary need (the most severe of the seven QLQ-C30 scales) at 3- and 8-week follow-up (0–100 scale). Five sensitivity analyses were conducted. Secondary
outcomes were change in the seven QLQ-C30 scales and survival.
Results: Totally 145 patients were randomised to early specialist palliative care versus 152 to standard care. Early specialist palliative care showed no effect on the primary outcome of change in primary need (−4.9 points (95% confidence interval −11.3 to +1.5 points); p = 0.14). The sensitivity analyses showed similar results. Analyses of the secondary outcomes, including survival, also showed no
differences, maybe with the exception of nausea/vomiting where early specialist palliative care might have had a beneficial effect.
Conclusion: We did not observe beneficial or harmful effects of early specialist palliative care, but important beneficial effects cannot
be excluded.
| Original language | English |
|---|---|
| Pages (from-to) | 814-824 |
| Number of pages | 11 |
| Journal | Palliative Medicine |
| Volume | 31 |
| Issue number | 9 |
| Early online date | 12 May 2017 |
| DOIs | |
| Publication status | Published - 1 Oct 2017 |
Bibliographical note
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by The Tryg Foundation (7-10-0838A, 7-12-0754) and the Danish Cancer Society (R16-A695, R114-A7232-14-S3).Keywords
- palliative care
- advanced cancer
- randomised clinical trial
- quality of life
- needs assessment
- patient satisfaction
- EORTC QLQ-C30
