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

Nipp, Ryan David; El‐Jawahri, Areej; Traeger, Lara; Jacobs, Jamie M.; Gallagher, Emily R.; Park, Elyse R.; Jackson, Vicki A.; Pirl, William F.; Temel, Jennifer S.; Greer, Joseph A.

doi:10.1177/0269216317751893

Cited by 34 publications

(30 citation statements)

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“…Future research should include longitudinal assessments to understand better how patients' care needs vary over time and in response to other factors, such as the receipt of certain cancer treatments or supportive care services, including geriatrics and palliative care. 42,43…”

Section: Discussionmentioning

confidence: 99%

Screening Tool Identifies Older Adults With Cancer at Risk for Poor Outcomes

Nipp

Thompson

Temel

et al. 2020

Journal of the National Comprehensive Cancer Network

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Background: Oncologists often struggle with managing the complex issues unique to older adults with cancer, and research is needed to identify patients at risk for poor outcomes. Methods: This study enrolled patients aged ≥70 years within 8 weeks of a diagnosis of incurable gastrointestinal cancer. Patient-reported surveys were used to assess vulnerability (Vulnerable Elders Survey [scores ≥3 indicate a positive screen for vulnerability]), quality of life (QoL; EORTC Quality of Life of Cancer Patients questionnaire [higher scores indicate better QoL]), and symptoms (Edmonton Symptom Assessment System [ESAS; higher scores indicate greater symptom burden] and Geriatric Depression Scale [higher scores indicate greater depression symptoms]). Unplanned hospital visits within 90 days of enrollment and overall survival were evaluated. We used regression models to examine associations among vulnerability, QoL, symptom burden, hospitalizations, and overall survival. Results: Of 132 patients approached, 102 (77.3%) were enrolled (mean [M] ± SD age, 77.25 ± 5.75 years). Nearly half (45.1%) screened positive for vulnerability, and these patients were older (M, 79.45 vs 75.44 years; P=.001) and had more comorbid conditions (M, 2.13 vs 1.34; P=.017) compared with nonvulnerable patients. Vulnerable patients reported worse QoL across all domains (global QoL: M, 53.26 vs 66.82; P=.041; physical QoL: M, 58.95 vs 88.24; P<.001; role QoL: M, 53.99 vs 82.12; P=.001; emotional QoL: M, 73.19 vs 85.76; P=.007; cognitive QoL: M, 79.35 vs 92.73; P=.011; social QoL: M, 59.42 vs 82.42; P<.001), higher symptom burden (ESAS total: M, 31.05 vs 15.00; P<.001), and worse depression score (M, 4.74 vs 2.25; P<.001). Vulnerable patients had a higher risk of unplanned hospitalizations (hazard ratio, 2.38; 95% CI, 1.08–5.27; P=.032) and worse overall survival (hazard ratio, 2.26; 95% CI, 1.14–4.48; P=.020). Conclusions: Older adults with cancer who screen positive as vulnerable experience a higher symptom burden, greater healthcare use, and worse survival. Screening tools to identify vulnerable patients should be integrated into practice to guide clinical care.

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Section: Discussionmentioning

confidence: 99%

Screening Tool Identifies Older Adults With Cancer at Risk for Poor Outcomes

Nipp

Thompson

Temel

et al. 2020

Journal of the National Comprehensive Cancer Network

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“…Further theoretical development can provide a stronger justification for defining core elements of palliative care interventions, suggest mediating and moderating mechanisms, and guide the choice of outcome measures. Few studies of palliative care have examined potential mediators and moderators [16,65,66], including factors as simple as the length of the palliative care visit or timing. In our review of individual RCTs, the link between elements of the intervention and the choice of particular survey outcome measures was commonly underspecified, perhaps dampening effects.…”

Section: Discussionmentioning

confidence: 99%

Impact of Interdisciplinary Outpatient Specialty Palliative Care on Survival and Quality of Life in Adults With Advanced Cancer: A Meta-Analysis of Randomized Controlled Trials

Hoerger

Wayser

Schwing

et al. 2018

Annals of Behavioral Medicine

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Background In advanced cancer, patients want to know how their care options may affect survival and quality of life, but the impact of outpatient specialty palliative care on these outcomes in cancer is uncertain. Purpose To estimate the impact of outpatient specialty palliative care programs on survival and quality of life in adults with advanced cancer. Methods Following PRISMA guidelines, we conducted a systematic review and meta-analysis of randomized controlled trials comparing outpatient specialty palliative care with usual care in adults with advanced cancer. Primary outcomes were 1 year survival and quality of life. Analyses were stratified to compare preliminary studies against higher-quality studies. Secondary outcomes were survival at other endpoints and physical and psychological quality-of-life measures. Results From 2,307 records, we identified nine studies for review, including five high-quality studies. In the three high-quality studies with long-term survival data (n = 646), patients randomized to outpatient specialty palliative care had a 14% absolute increase in 1 year survival relative to controls (56% vs. 42%, p < .001). The survival advantage was also observed at 6, 9, 15, and 18 months, and median survival was 4.56 months longer (14.55 vs. 9.99 months). In the five high-quality studies with quality-of-life data (n = 1,398), outpatient specialty palliative care improved quality-of-life relative to controls (g = .18, p < .001), including for physical and psychological measures. Conclusions Patients with advanced cancer randomized to receive outpatient specialty palliative care lived longer and had better quality of life. Findings have implications for improving care in advanced cancer.

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“…Our study findings suggest that there is a need to promote palliative care services among men. 33 Educational interventions have been shown to lead to more favorable attitudes toward PC 11,12, 28 and broad-scale public service announcements or messaging interventions could be considered. Moreover, clinicians may wish to consider gender differences while discussing PC option/referral with their patients.…”

Section: Discussionmentioning

confidence: 99%