Early specialist palliative care fails to improve QoL in patients undergoing abdominal surgery for cancer: JAMA
USA: A randomized clinical trial involving 235 adults undergoing abdominal surgeries for cancer showed no evidence that a specialist palliative care intervention improves time alive out of the hospital, survival, or quality of life (QoL).
Previous studies have shown that specialist palliative care is beneficial for patients undergoing medical treatment of cancer; however, data are lacking on specialist palliative care is similarly helpful for patients undergoing surgery for cancer. To fill this knowledge gap, Myrick C. Shinall Jr from Vanderbilt University Medical Center in Nashville, Tennessee, and colleagues aimed to determine the impact of specialist palliative care on patients undergoing surgery for the cure or durable cancer control.
In their study published in JAMA Surgery, the research team addressed whether patients undergoing nonpalliative surgery for cancer should receive early specialist palliative care.
The single-centre RCT was conducted in which patients scheduled for specified intra-abdominal cancer surgery were recruited from an academic urban referral centre. They were randomly assigned in a ratio of 1:1 to the usual care group or the specialist palliative care intervention. Two hundred thirty-five adults (median age 65; 60% were men) undergoing one of eight scheduled nonpalliative abdominal operations for cancer were included. The most common operation was partial hepatectomy, pancreatectomy, and radical cystectomy, and the most common cancers included pancreatic, colorectal, and bladder cancer.
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
