Effect Of Early Palliative Care Research Articles

Meta-Analysis of Effects of Early Palliative Care on Health-Related Outcomes Among Advanced Cancer Patients.

Early palliative care (PC) has received more attention for improving health-related outcomes for advanced cancer patients in recent years, but the results of previous studies are inconsistent. This study aimed to use meta-analysis and trial sequence analysis to evaluate the effect of early PC on health-related outcomes of advanced cancer patients. All English publications were searched in PubMed, Web of Science, Embase, and the Cochrane Library from inception to March 2023, with a restriction that the study type was a randomized controlled trial. The results showed that early PC positively affected quality of life, satisfaction with care, and symptom burden reduction. However, early PC had no significant effect on anxiety or survival. Trial sequence analysis results showed that the effect of early PC on the quality of life was stable. This systematic review suggested that early PC could positively affect health-related outcomes for advanced cancer patients. Early PC can be used widely in clinical settings to improve health-related outcomes of advanced cancer. However, because of the trial sequence analysis results, further well-designed, clinical, randomized controlled trials with larger sample sizes are necessary to draw definitive conclusions.

Effect of early palliative care on caregivers of adult patients with chronic diseases: A systematic review and meta-analysis of randomized controlled trials

The aim of this research was to examine the effects of early palliative care on individuals who provide care for adult patients with chronic diseases. From the earliest date until November 1, 2022, the databases of Scopus, PubMed, Web of Science, Iranmedex, and Scientific Information Database were thoroughly searched using purpose-related keywords. To rate the caliber of randomized control trials and quasi-experimental research, the Joanna Briggs Institute (JBI) critical evaluation checklist was utilized. A total of 800 patients with chronic disease were included in five studies. This study demonstrated that early palliative care treatments had a similar impact on caregivers' quality of life (QoL) as routine care and delayed palliative care interventions (ES: -0.01, 95%CI: -0.20 to 0.17, Z=0.15, I2:0.0%, P=0.88). As compared to the normal care group, the early care group's caregivers' depression was modestly reduced by the intervention, but this difference was not statistically significant (ES: -0.06, 95%CI: -0.36 to 0.23, Z=0.43, I2:0.0%, P=0.67). Early palliative care reduced caregiver anxiety, however, the difference between the intervention group and the group receiving standard care was not statistically significant (ES: -0.25, 95%CI: -0.64 to 0.15, Z=1.23, I2:0.0%, P=0.22). Caregivers' burdens were reported based on three dimensions demand, stress, and objective. Results found the intervention caused a non-significant decrease in the demand dimension (WMD: -0.48, 95% CI: -1.13 to 0.17, Z=1.44, I2:0.0%, P=0.15) and a significant decrease in the stress dimension (WMD: -0.65, 95% CI: -1.26 to -0.04, Z=2.09, I2:0.0%, P=0.04), in the intervention group compared to the routine care. In contrast, the intervention did not affect the objective dimension (WMD: 0.30, 95%CI: -0.48 to 1.08, Z=0.76, I2:0.0%, P=0.45) in the intervention group than in routine care. Therefore, it is suggested that more interventional studies be conducted in this area in the future.

Effects of early palliative care on patients with incurable cancer: A meta‐analysis and systematic review

This meta-analysis aims to compare the effects of early palliative care on patients with incurable cancer with those of standard oncologic care or on-demand palliative care. Pubmed, Embase, Web of Science, Cochrane Library, ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform (ICTRP) were searched for relevant randomised controlled trials. We also screened reference lists of included studies for additional qualified studies. We used Cochrane Collaboration Risk of Bias Tool to evaluate quality of included studies. DerSimonian and Laird's random effects meta-analysis was used to synthesise the effects. Sixteen in 1376 studies were included. The pooled data suggested that patients receiving early palliative care had better quality of life (SMD = 0.737, 95% CI: 0.240-1.234), fewer symptoms (SMD = 0.304, 95% CI: 0.097-0.510), better mood (SMD = -0.443, 95% CI: -0.605 to -0.282), better survival (hazard ratio [HR] of death: HR = 1.521, 95% CI: 1.521-1.923; 1-year overall survival probability: HR = 1.238, 95% CI: 1.031-1.486) and higher probability of dying at home (HR = 1.153, 95% CI: 1.027-1.295) than patients in the control group. And there is no difference between resource use. Early palliative care improves lives of patients with incurable cancer, but the evidence level is low because of high heterogeneity of quality of life and small numbers of included studies for other results.

Effects of Early Palliative Care in Advanced Cancer Patients: A Meta-Analysis.

Objective: Advanced cancer patients often suffer from a reduced quality of life (QoL) and cancer-related symptoms. Early palliative care may improve their QoL and symptom severity. Methods: We conducted a meta-analysis of the effects of early palliative care on QoL, symptom severity, and other outcomes in advanced cancer patients, and searched PubMed, Embase, CINAHL, MEDLINE, and the Cochrane Library databases for potential randomized controlled trials (RCTs). The primary outcome was QoL. The secondary outcomes were symptom intensity and functional well-being (Trial Outcome Index, TOI). The study protocol has been registered and approved by PROSPERO (CRD42020164047). Results: We obtained 12 RCTs enrolling 2980 participants. Compared with the usual care, early palliative care significantly improved QoL at ≤ 3 months (SMD = .16, 95% CI = .05-.27) and when treated more 3months (SMD = .26, 95% CI = .11-.40). Compared with usual treatment, patients who received early palliative care exhibited a significant reduction in symptom intensity when treated more than 3months (SMD = .18, 95% CI = .06-.31) and in TOI ≤ 3months (SMD = .28, 95% CI = .11-.45). Conclusions: Early palliative care improves QoL, symptom intensity, and TOI in advanced cancer patients. We recommend introducing early palliative care for advanced cancer patients as the approach provides additional clinical benefits compared with usual care.

Effect of Early Palliative Care on End-of-Life Health Care Costs: A Population-Based, Propensity Score-Matched Cohort Study.

This study aimed to investigate the impact of early versus not-early palliative care among cancer decedents on end-of-life health care costs. Using linked administrative databases, we created a retrospective cohort of cancer decedents between 2004 and 2014 in Ontario, Canada. We identified those who received early palliative care (palliative care service used in the hospital or community 12 to 6 months before death [exposure]). We used propensity score matching to identify a control group of not-early palliative care, hard matched on age, sex, cancer type, and stage at diagnosis. We examined differences in average health system costs (including hospital, emergency department, physician, and home care costs) between groups in the last month of life. We identified 144,306 cancer decedents, of which 37% received early palliative care. After matching, we created 36,238 pairs of decedents who received early and not-early (control) palliative care; there were balanced distributions of age, sex, cancer type (24% lung cancer), and stage (25% stage III and IV). Overall, 56.3% of early group versus 66.7% of control group used inpatient care in the last month (P < .001). Considering inpatient hospital costs in the last month of life, the early group used an average (±standard deviation) of $7,105 (±$10,710) versus the control group of $9,370 (±$13,685; P < .001). Overall average costs (±standard deviation) in the last month of life for patients in the early versus control group was $12,753 (±$10,868) versus $14,147 (±$14,288; P < .001). Receiving early palliative care reduced average health system costs in the last month of life, especially via avoided hospitalizations.

Effects of Early Palliative Care for Family Caregivers of Persons with Advanced Heart Failure: The ENABLE CHF-PC Randomized Controlled Trial (CS201A)

Effects of Early Palliative Care for Family Caregivers of Persons with Advanced Heart Failure: The ENABLE CHF-PC Randomized Controlled Trial (CS201A)

Effects of Early Palliative Care for Family Caregivers of Persons with Advanced Heart Failure: The ENABLE CHF-PC Randomized Controlled Trial (FR440B)

•Explain the experience and tasks undertaken by family caregivers of patients with advanced heart failure.•Summarize results and implications of the ENABLE CHF-PC trial for family caregivers. Family caregivers (CGs) provide high levels of care to persons with advanced heart failure and are at high risk for distress and poor quality of life (QoL). Determine the effect of a nurse-led palliative care telehealth intervention (ENABLE CHF-PC) on advanced heart failure CGs QoL and mood over 16 weeks. Intervention versus usual care single-blind randomized controlled trial (August 2016-October 2018; ClinicalTrials.gov: NCT02505425). Family caregivers of patients with NYHA Class III/IV heart failure were recruited from outpatient heart failure clinics at a large academic tertiary care medical center and a Veteran Affairs Medical Center. Intervention-group caregivers received four weekly psychosocial and problem-solving support telephonic sessions facilitated by a trained nurse coach plus monthly follow-up for 48 weeks. The primary outcomes were QoL (Bakas Caregiver Outcomes Scale [BCOS]), mood (Hospital Anxiety and Depression Scale [HADS]), and burden (Montgomery-Borgatta Caregiver Burden scales [MBCB]) over 16 weeks. Of 159 CGs randomized to ENABLE CHF-PC (n=83) or usual care (n=76), mean age was 57.9, 85.4% were female, 51.9% were African-American, and 65.2% were the patient's spouse/partner. Over 16 weeks, the mean BCOS score improved 0.7 points (SE=1.7) in the intervention arm and 1.1 points (SE=1.6) in the usual care arm (difference, -0.4; 95% CI, -5.1-4.3; d=-0.03). No relevant between-group differences were observed for HADS-anxiety (d=-0.02), HADS-depression (d=0.03), and the MBCB scales (d range: -0.18-0.0). P-values for all outcomes were >.05. This 2-site randomized controlled trial of the ENABLE CHF-PC intervention for family caregivers of advanced heart failure patients, over half of whom were African-Americans and most of whom were not distressed at baseline, did not demonstrate clinically improved QoL, mood, or burden compared to usual care over 16 weeks.

Effect of early palliative care for patients with glioblastoma (EPCOG): a randomised phase III clinical trial protocol

​IntroductionRandomised controlled trials (RCTs) have shown a positive effect of early integration of palliative care (EIPC) in various advanced cancer entities regarding patients’ quality of life (QoL), survival, mood, caregiver...

Effect of Early Palliative Care on the Quality of Life of Patients with Advanced Head and Neck Cancers: A Phase 3 Randomized Controlled Trial

Effect of Early Palliative Care on the Quality of Life of Patients with Advanced Head and Neck Cancers: A Phase 3 Randomized Controlled Trial

Effect of early palliative care on quality of life in patients with non-small-cell lung cancer.

Patients with metastatic non-small-cell lung cancer (nsclc) experience great pain and stress. Our study aimed to explore the effect of early palliative care on quality of life in patients with nsclc. A total of 150 patients were randomly divided into two groups: control group with conventional care and study group with early palliative care. The quality of life (qol) rating scale and self-rating scale of life quality (sslq) were used to analyze the patients' quality of life. The Hospital Anxiety and Depression Scale-D/A (hads-d/a) and Patient Health Questionnaire 9 (phq-9) were used to analyze the patients' mood. Pulmonary function indexes of peak expiratory flow (pef), functional residual capacity (frc), and trachea-esophageal fistula 25% (tef 25%) were analyzed using the lung function detector. The qol and sslq scales scores of patients receiving early palliative care were significantly higher than those in the control group (p < 0.05). Moreover, the questionnaire results of the hads-d/a and phq-9 were better in patients receiving palliative care than in the control group (p < 0.05 or p < 0.01). In addition, analytical results of pulmonary function showed that the levels of pef, frc, and tef 25% in patients assigned to early palliative care were remarkably higher than those in the control group (p < 0.01 or p < 0.001). These data demonstrate that early palliative care improves life quality, mood, and pulmonary function of nsclc patients, indicating that early palliative care could be used as a clinically meaningful and feasible care model for patients with metastatic nsclc.

Differential effects of early palliative care based on the age and sex of patients with advanced cancer from a randomized controlled trial

Background: Early palliative care interventions enhance patient outcomes, including quality of life, mood, and coping, but it remains unclear whether certain subgroups of patients are more likely to benefit from early palliative care. We explored whether age and sex moderate the improved outcomes seen with early palliative care. Methods: We performed a secondary analysis of data from a randomized trial of 350 patients with advanced lung and non-colorectal gastrointestinal cancer. Patients received an early palliative care intervention integrated with oncology care or usual oncology care alone. We used linear regression to determine if age (older or younger than 65) and sex moderated the effects of the intervention on quality of life (Functional Assessment of Cancer Therapy–General (FACT-G)), depression symptoms (Patient Health Questionnaire 9 (PHQ-9)), and coping (Brief COPE) within lung and gastrointestinal subgroups. Results: At 24 weeks, younger patients with lung cancer receiving early palliative care reported increased use of active coping (B = 1.74; p = 0.02) and decreased use of avoidant coping (B = –0.97; p = 0.02), but the effects of early palliative care on these outcomes were not significant for older patients. Male patients with lung cancer assigned to early palliative care reported better quality of life (FACT-G: B = 9.31; p = 0.01) and lower depression scores (PHQ-9: B = –2.82; p = 0.02), but the effects of early palliative care on these outcomes were not significant for female patients. At 24 weeks, we found no age or sex moderation effects within the gastrointestinal cancer subgroup. Conclusion: Age and sex moderate the effects of early palliative care for patients with advanced lung cancer. Early palliative care may need to be tailored to individuals’ unique sociodemographic and clinical characteristics.

Role of Patient Coping Strategies in Understanding the Effects of Early Palliative Care on Quality of Life and Mood.

Purpose The early integration of oncology and palliative care (EIPC) improves quality of life (QOL) and mood for patients with advanced cancer. However, the mechanisms by which EIPC benefits these outcomes remain unclear. We therefore examined whether EIPC improved patients' coping strategies and if changes in coping accounted for intervention effects on QOL and depressive symptoms. Patients and Methods For this secondary analysis of an EIPC trial, we examined data from 350 patients with newly diagnosed incurable lung or GI cancer. Participants completed assessments of QOL (Functional Assessment of Cancer Therapy-General), depressive symptoms (Patient Health Questionnaire-9), and coping (Brief COPE) at baseline and 24 weeks. We used linear regression to test intervention effects on use of coping strategies and mediation regression models with bias-corrected bootstrapping to examine whether improvements in coping mediated the effects of early palliative care on patient-reported outcomes. Results Compared with usual oncology care, EIPC significantly increased patient use of approach-oriented coping strategies ( B = 1.09; SE = 0.44; P = .01) and slightly reduced use of avoidant strategies ( B = -0.44; SE = 0.23; P = .06) from baseline to 24 weeks. Also, the increased use of approach-oriented coping and reduction in avoidant coping were associated with higher QOL and lower depressive symptoms at 24 weeks. The positive changes in approach-oriented coping, but not avoidant coping, significantly mediated the effects of EIPC on QOL (indirect effect, 1.27; 95% CI, 0.33 to 2.86) and depressive symptoms (indirect effect, -0.39; 95% CI, -0.87 to -0.08). Conclusion Patients with incurable cancer who received EIPC showed increased use of approach-oriented coping, which was associated with higher QOL and reduced depressive symptoms. Palliative care may improve these outcomes by providing patients with the skills to cope effectively with life-threatening illness.

African American perceptions of early palliative care in oncology.

104 Background: While ASCO guidelines recommend early palliative care (PC) for patients with metastatic cancer, few African Americans (AA) have participated in PC trials and little data exist on the acceptability and effect of early PC in this population. Using the ADAPT-ITT framework for culturally tailoring evidence-based interventions, we assessed perceptions of PC and its early introduction in oncology in AAs. Methods: We conducted four focus groups with AAs from community centers in Miami. We enrolled adults without a history of cancer to approximate the knowledge and beliefs of someone with newly diagnosed cancer. Focus groups explored knowledge of PC, value of different components of early PC, and perceptions about introducing PC early after cancer diagnosis. We recorded and transcribed the focus groups, performing thematic analysis with NVivo. Results: Thirty-seven AAs participated. Over half were female (24/37), and median age was 54 years old (range 35-71). Participants had little to no knowledge of PC. Lack of familiarity was attributed to AAs receiving sub-standard care and the belief that PC has been kept from AAs. Rather than being concerned that it might result in less cancer treatment, they reported that PC was actually part of doing everything possible for cancer, and it is the “best care.” PC was viewed as a solution to a major theme of doctors not providing adequate information for patients and families to prepare for negative outcomes such as death. However, some objected to discussing specific survival estimates for fear of speaking them into existence. Distinctions were drawn between what doctors manage (treatments) and what God manages (life/death). Participants could not understand why PC would be reserved for later in the course of illness instead of immediately after cancer diagnosis (“Don’t wait until I’m dying; give it to me now!”). PC was described as “supervising your needs and making sure they are addressed.” Conclusions: AAs were enthusiastic about early PC in oncology, but did not support providing specific estimates of survival. End-of-life planning was considered by some to be spiritual and not medical.

OA 11.04 Effect of Early Palliative Care on Aggressiveness of Cancer Care near End of Life in Lung Cancer Patient

OA 11.04 Effect of Early Palliative Care on Aggressiveness of Cancer Care near End of Life in Lung Cancer Patient

A parallel-group randomized clinical trial of individually tailored, multidisciplinary, palliative rehabilitation for patients with newly diagnosed advanced cancer: the Pal-Rehab study protocol

BackgroundThe effect of early palliative care and rehabilitation on the quality of life of patients with advanced cancer has been only sparsely described and needs further investigation. In the present trial we combine elements of early, specialized palliative care with cancer rehabilitation in a 12-week individually tailored, palliative rehabilitation program initiated shortly after a diagnosis of advanced cancer.MethodsThis single center, randomized, controlled trial will include 300 patients with newly diagnosed advanced cancer recruited from the Department of Oncology, Vejle Hospital. The patients are randomized to a specialized palliative rehabilitation intervention integrated in standard oncology care or to standard oncology care alone. The intervention consists of a multidisciplinary group program, individual consultations, or a combination of both. At baseline and after six and 12 weeks the patients will be asked to fill out questionnaires on symptoms, quality of life, and symptoms of depression and anxiety. Among the symptoms and problems assessed, patients are asked to indicate the problem they need help with to the largest extent. The effect of the intervention on this problem is the primary outcome measure of the study. Secondary outcome measures include survival and economic consequences.DiscussionTo our knowledge the Pal-Rehab study is the first randomized, controlled, phase III trial to evaluate individually tailored, palliative rehabilitation in standard oncology care initiated shortly after an advanced cancer diagnosis. The study will contribute with evidence on the effectiveness of implementing early palliative care in standard oncology treatment and hopefully offer new knowledge and future directions as to the content of palliative rehabilitation programs.Trial RegistrationClinicaltrials.gov Identifier: NCT02332317, registered retrospectively on December 30, 2014. One study participant had been enrolled at the time.

Research protocol on early palliative care in patients with acute leukaemia after one relapse

ObjectivesAccording to the American Society of Clinical Oncology palliative care referrals are made within the last 3 weeks of patients’ lives and most frequently when oncological treatments have ceased especially...

Early palliative care for adults with advanced cancer.

Early palliative care for adults with advanced cancer.

Randomised clinical trial of early specialist palliative care plus standard care versus standard care alone in patients with advanced cancer: The Danish Palliative Care Trial

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.

An Ethical Perspective on Palliative Care

Continuing Professional Education (CPE) Information The Continuing Professional Education (CPE) quiz for this article is available for free to Academy members through the MyCDRGo app (available for iOS and Android devices) and via www.eatrightPRO.org. Simply log in with your Academy of Nutrition and Dietetics or Commission on Dietetic Registration username and password, go to the My Account section of My Academy Toolbar, click the “Access Quiz” link, click “Journal Article Quiz” on the next page, then click the “Additional Journal CPE quizzes” button to view a list of available quizzes. Non-members may take CPE quizzes by sending a request to [email protected] There is a fee of $45 per quiz (includes quiz and copy of article) for non-member Journal CPE. CPE quizzes are valid for 1 year after the issue date in which the articles are published. A multi-dimensional paradigm shift in health care continues to spread as palliative care grows into an overarching concept integrated throughout the field. Once thought of in terms of hospice and long-term care units, research indicates that the concept can improve not only quality of life and patient satisfaction, but perhaps extend life as well in patients who might otherwise suffer less-desirable outcomes. 1 Temel J.S. Greer J.A. Muzikansky A. et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 363: 733-742 Crossref PubMed Scopus (5031) Google Scholar , 2 Kelley A.S. Meier D.E. Palliative care—A shifting paradigm. N Engl J Med. 2010; 363: 781-782 Crossref PubMed Scopus (116) Google Scholar , 3 Dionne-Odom J.N. Azuero A. Lyons K.D. et al. Benefits of early versus delayed palliative care to informal family caregivers of patients with advanced cancer: Outcomes from the ENABLE III Randomized Controlled Trial. J Clin Oncol. 2015; 33: 1446-1452 Crossref PubMed Scopus (296) Google Scholar , 4 Greer J.A. Pirl W.F. Jackson V.A. et al. Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. J Clin Oncol. 2012; 30: 394-400 Crossref PubMed Scopus (402) Google Scholar , 5 American Academy of PediatricsPolicy Statement: Pediatric palliative care and hospice care commitments, guidelines, and recommendations. Pediatrics. 2013; 132: 966-972 Crossref PubMed Scopus (291) Google Scholar These quantitative results, added to strong anecdotal support, help build a compelling case for the shift, particularly as it appeals to a heightened sense of ethics in terms of beneficence, non-maleficence, and justice. This brings a multi-dimensional dynamic to the discussion of wellness and improved outcomes, and registered dietitian nutritionists (RDNs) accustomed to the concept report it’s completely in line with the profession’s traditional model of optimizing patient health through nutrition. The objective of the present article is to first explain the concept of palliative care, consider it from the perspective of ethics, and offer examples of challenges faced in the field of nutrition, as well as resources for the practitioner’s benefit. The Continuing Professional Education (CPE) quiz for this article is available for free to Academy members through the MyCDRGo app (available for iOS and Android devices) and via www.eatrightPRO.org. Simply log in with your Academy of Nutrition and Dietetics or Commission on Dietetic Registration username and password, go to the My Account section of My Academy Toolbar, click the “Access Quiz” link, click “Journal Article Quiz” on the next page, then click the “Additional Journal CPE quizzes” button to view a list of available quizzes. Non-members may take CPE quizzes by sending a request to [email protected] There is a fee of $45 per quiz (includes quiz and copy of article) for non-member Journal CPE. CPE quizzes are valid for 1 year after the issue date in which the articles are published.

LBA49 - palliative care Evaluation of effects of early palliative care on quality of life of advanced cancer patients. A multicenter controlled randomised clinical trial

LBA49 - palliative care Evaluation of effects of early palliative care on quality of life of advanced cancer patients. A multicenter controlled randomised clinical trial