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- Title
Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial.
- Authors
Aslakson, Rebecca A.; Rickerson, Elizabeth; Fahy, Bridget; Waterman, Brittany; Siden, Rachel; Colborn, Kathryn; Smith, Shelby; Verano, Mae; Lira, Isaac; Hollahan, Caroline; Siddiqi, Amn; Johnson, Kemba; Chandrashekaran, Shivani; Harris, Elizabeth; Nudotor, Richard; Baker, Joshua; Heidari, Shireen N.; Poultsides, George; Conca-Cheng, Alison M.; Cook Chapman, Allyson
- Abstract
Key Points: Question: Does proactive specialist palliative care improve patient-reported outcomes in patients receiving curative-intent surgeries for high morbidity and mortality upper gastrointestinal cancers? Findings: In this randomized clinical trial across 5 geographically diverse cancer centers that included 356 adults randomized to either surgeon alone or surgeon–palliative care team comanagement, there was no significant difference in postoperative patient-reported outcomes, such as quality of life or mental health. Palliative care was well tolerated by study patient and practitioner participants with no associated harms. Meaning: Data from this study do not suggest benefits with palliative care for surgical oncology patients with newly diagnosed cancers who were pursuing curative-intent operations; integration of palliative care specialists could possibly be more effectively targeted toward patients with poorer baseline quality of life and functionality. Importance: Involvement of palliative care specialists in the care of medical oncology patients has been repeatedly observed to improve patient-reported outcomes, but there is no analogous research in surgical oncology populations. Objective: To determine whether surgeon–palliative care team comanagement, compared with surgeon team alone management, improves patient-reported perioperative outcomes among patients pursuing curative-intent surgery for high morbidity and mortality upper gastrointestinal (GI) cancers. Design, Setting, and Participants: From October 20, 2018, to March 31, 2022, a patient-randomized clinical trial was conducted with patients and clinicians nonblinded but the analysis team blinded to allocation. The trial was conducted in 5 geographically diverse academic medical centers in the US. Individuals pursuing curative-intent surgery for an upper GI cancer who had received no previous specialist palliative care were eligible. Surgeons were encouraged to offer participation to all eligible patients. Intervention: Surgeon–palliative care comanagement patients met with palliative care either in person or via telephone before surgery, 1 week after surgery, and 1, 2, and 3 months after surgery. For patients in the surgeon-alone group, surgeons were encouraged to follow National Comprehensive Cancer Network–recommended triggers for palliative care consultation. Main Outcomes and Measures: The primary outcome of the trial was patient-reported health-related quality of life at 3 months following the operation. Secondary outcomes were patient-reported mental and physical distress. Intention-to-treat analysis was performed. Results: In total, 359 patients (175 [48.7%] men; mean [SD] age, 64.6 [10.7] years) were randomized to surgeon-alone (n = 177) or surgeon–palliative care comanagement (n = 182), with most patients (206 [57.4%]) undergoing pancreatic cancer surgery. No adverse events were associated with the intervention, and 11% of patients in the surgeon-alone and 90% in the surgeon–palliative care comanagement groups received palliative care consultation. There was no significant difference between study arms in outcomes at 3 months following the operation in patient-reported health-related quality of life (mean [SD], 138.54 [28.28] vs 136.90 [28.96]; P =.62), mental health (mean [SD], −0.07 [0.87] vs −0.07 [0.84]; P =.98), or overall number of deaths (6 [3.7%] vs 7 [4.1%]; P >.99). Conclusions and Relevance: To date, this is the first multisite randomized clinical trial to evaluate perioperative palliative care and the earliest integration of palliative care into cancer care. Unlike in medical oncology practice, the data from this trial do not suggest palliative care–associated improvements in patient-reported outcomes among patients pursuing curative-intent surgeries for upper GI cancers. Trial Registration: ClinicalTrials.gov Identifier: NCT03611309 This randomized clinical trial evaluates the use of surgeon–palliative care team comanagement to improve health-related quality of life among individuals undergoing curative-intent surgery for upper gastrointestinal cancers.
- Subjects
PERIOPERATIVE care; ACADEMIC medical centers; HEALTH status indicators; SURGERY; PATIENTS; GASTROINTESTINAL tumors; T-test (Statistics); RANDOMIZED controlled trials; QUALITY of life; RESEARCH funding; DATA analysis software; PALLIATIVE treatment
- Publication
JAMA Network Open, 2023, Vol 6, Issue 5, pe2314660
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2023.14660