Early specialist palliative care fails to improve QoL in patients undergoing abdominal surgery for cancer: JAMA

The specialist palliative intervention comprised of preoperative consultation, three follow-up visits or phone calls before e postoperative day 90, inpatient visits twice weekly or more during the postoperative hospital stay, and an inpatient visit if the patient was readmitted. Palliative care included assessing and treating pain, constipation, nausea, delirium, sleep disturbances, psychosocial stress, and immobility.

The Functional Assessment of Cancer Therapy measured physical and functional QoL at postoperative day (POD) 90–General (FACT-G) Trial Outcome Index (TOI), scored on a range of 0 to 56; a higher score represents higher functional and physical QoL (prespecified primary endpoint). Prespecified secondary endpoints were overall QoL at POD 90 measured by FACT-G, 1-year overall survival, and days alive at home until POD 90.

The study led to the following findings:

• One hundred fourteen patients in the intervention group and one in the usual care group received specialist palliative care.
• Adjusted median scores on the FACT-G TOI measure of functional and physical QoL did not differ between groups (intervention score, 46.77; usual care score, 46.23).
• The intervention vs usual care group odds ratio (OR) was 1.17.
• Palliative care did not improve the overall quality of life measured by the FACT-G score (intervention vs usual care OR, 1.09), days alive at home (OR, 0.87), or 1-year overall survival (hazard ratio, 0.97).

"Our findings showed that early specialist palliative care did not significantly improve outcomes for patients undergoing abdominal operations for cancer," the researchers concluded.

Reference:

Shinall MC, Martin SF, Karlekar M, et al. Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer: A Randomized Clinical Trial. JAMA Surg. Published online May 10, 2023. doi:10.1001/jamasurg.2023.1396