Randomized trial of early integrated palliative and oncology care.

Abstract

104 Background: Early palliative care (PC) improves outcomes in patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC) and in patients identified by clinicians as having poor prognosis, advanced cancer. We evaluated the impact of early, integrated palliative and oncology care in patients with newly diagnosed lung and gastrointestinal (GI) cancer. Methods: Between 5/2/11 and 7/20/15, we randomly assigned patients with newly diagnosed incurable lung (NSCLC, small cell, mesothelioma) or GI (pancreas, hepatobiliary, gastric, esophageal) cancer to PC integrated with oncology care (monthly visits with PC) or usual oncology care. We used the Functional Assessment of Cancer Therapy-General (FACT-G) to assess quality of life (QOL) and the Patient Health Questionniare-9 (PHQ-9) for mood at baseline, weeks 12 and 24. We also assessed patients’ coping styles (Brief COPE), perceptions of likelihood of cure and communication about end-of-life (EOL) preferences. To evaluate intervention effects on patient-reported outcomes, we performed chi square tests and linear regression, controlling for baseline values and clinical factors. Results: We randomized 350 patients (175 per group), including 191 lung and 159 GI cancer patients. Patients assigned to early PC had higher QOL (B = 5.36, 95% CI: 2.04 to 8.69, p = 0.002) and less depression on the PHQ-9 (B = -1.17, 95% CI: -2.33 to -0.01, p = 0.048) at 24 weeks, but not at 12 weeks. Also at 24 weeks, the intervention group was significantly more likely to report using active and engaged coping styles compared to the usual care group (B = 1.09, 95% CI: 0.23 to 1.96, p = 0.013). Similar proportions of patients at 24 weeks reported that their cancer was unlikely to be cured (36/105 [33.6%] in PC and 43/115 [37.4%] in usual care) but more patients assigned to early PC reported they discussed their EOL preferences (35/116 [30.2%] versus 17/117 [14.5%], p = 0.004). Change in QOL over time differed between the lung and GI cancer cohorts. Conclusions: Early PC improved QOL, mood, coping, and the frequency of EOL discussions in patients with newly diagnosed lung and GI cancer. The benefits of the integrated care model extend to other populations with advanced disease and include improved communication about EOL care. Clinical trial information: NCT01401907.