Abstract
23 Background: Early phase clinical trials usually include patients (pts) with advanced disease who have failed to standard therapies. Early palliative care (EPC) for these pts has shown to improve quality of life and even survival. Pallia 10 score (from 1 to 10) is a tool developed by the French Palliative Care Society to identify the best time to introduce palliative care. Methods: We assessed the Pallia 10 score and other prognostic factors (age, ECOG, Royal Marsden Hospital (RMH) score, LDH and albumin levels, number (nb) of prior systemic treatments and metastatic sites) in pts enrolled in phase I trials (P1CT) prospectively during 2 periods of time (cohort 1 (C1) and 2 (C2)). A double-blind assessment of the Pallia 10 score was done during 15 days by a member of the palliative care unit in C2. A Pallia 10 > 3 motivated a dedicated palliative care consultation. Results: From 01/07/2018 to 01/11/2018 (C1) and from 01/12/2020 to 16/04/2021 (C2), a total of 85 pts were assessed in C1 and 302 in C2. Gastro-intestinal (23%), hematological (14%) and lung (11%) cancer were the most frequent tumor types. Pallia 10 score and prognostic factors were similar between both cohorts (Table). On C1 and C2, 12% and 4% of pts had a dedicated palliative consultation with median time of referral of 18 and 2 months (m) after the P1CT onset (p = 0.003), with a median Pallia 10 score of 1.5 and 2 (p = 0.65), respectively. Overall, 75% and 76% of pts in C1 and C2 were still alive beyond 3m after discontinuation of the P1CT (p = 0.91), followed by at least one subsequent treatment in 56% and 54% of pts. In C2, assessment of Pallia 10 score was significantly different between palliative care physician (median 5, range 3-8), phase I physician (median 1, range 1 -6) and phase I nurse (median 3, range 1-8) (p < 0.001). Conclusions: Only a few patients included in P1CT were referred to the palliative care unit. Median Pallia 10 score was low when assessed by the phase I physician which suggests the need for a better tool to implement EPC in clinical practice and trials.[Table: see text]
Highlights
Multiples studies have demonstrated that early palliative care enhances quality of life with fewer refractory symptoms and improved survival in patients with advanced cancer[1,2,3,4], leading to the integration of supportive and palliative care as a pillar in the guidelines of several oncology organizations such as the American Society of Clinical Oncology (ASCO) [5] or the European Society of Medical Oncology (ESMO) [6] for the management of cancer patients with advanced disease.Diverse clinical and biological markers can be used as prognostic and predictive factors for cancer patients[7,8,9]
We assessed the PALLIA 10 score and other prognostic factors (age, ECOG, Royal Marsden Hospital (RMH) score, LDH and albumin levels, number of prior systemic treatments and metastatic sites) in patients enrolled in phase I trials at Gustave Roussy Cancer Center prospectively during 2 periods of time (cohort 1 (C1) and 2 (C2))
In Cohort 2 (C2), assessment of PALLIA 10 score was significantly different between palliative care physician, phase I physician and phase I nurse (p
Summary
Multiples studies have demonstrated that early palliative care enhances quality of life with fewer refractory symptoms and improved survival in patients with advanced cancer[1,2,3,4], leading to the integration of supportive and palliative care as a pillar in the guidelines of several oncology organizations such as the American Society of Clinical Oncology (ASCO) [5] or the European Society of Medical Oncology (ESMO) [6] for the management of cancer patients with advanced disease.Diverse clinical and biological markers can be used as prognostic and predictive factors for cancer patients[7,8,9]. Multiples studies have demonstrated that early palliative care enhances quality of life with fewer refractory symptoms and improved survival in patients with advanced cancer[1,2,3,4], leading to the integration of supportive and palliative care as a pillar in the guidelines of several oncology organizations such as the American Society of Clinical Oncology (ASCO) [5] or the European Society of Medical Oncology (ESMO) [6] for the management of cancer patients with advanced disease. The French palliative care society (SFAP) tried in this context to create a tool, named PALLIA 10, a score composed of ten questions, evaluating multiples aspects of the patient's daily life, ranging from the presence of physical or psychological refractory symptoms to the evolution and the comprehension of the stage of the disease. PALLIA 10 score (ranging from 1 to 10) is a tool developed by the French Palliative Care Society to identify the best time to introduce palliative care
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