Impact of early palliative care on overall survival of patients with metastatic upper gastrointestinal cancers treated with first-line chemotherapy: a randomised phase III trial

Hutt, Emilie; Silva, Arlette Da; Bogart, Émilie; Lay-Diomande, Sara Le; Pannier, Diane; Delaine-Clisant, Stéphanie; Deley, Marie-Cécile Le; Adenis, Antoine

doi:10.1136/bmjopen-2017-015904

Cited by 13 publications

(7 citation statements)

References 16 publications

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“…So far, only limited data are available on the specific challenges of palliative care interventions in the context of STS. Similarities can be found comparing our patients to other well-defined cohorts with different oncologic diseases receiving specialised palliative care intervention, especially when being integrated early into the therapeutic schedule [9,23,24,28]. Patients with advanced STS are known to require multidisciplinary approaches due to the aggressiveness of the heterogeneous diseases and the high occurrence of a severe symptom burden [6].…”

Section: Discussionsupporting

confidence: 60%

Impact of a specialised palliative care intervention in patients with advanced soft tissue sarcoma – a single-centre retrospective analysis

et al. 2021

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Background Soft tissue sarcomas (STS) account for less than 1% of all malignancies. Approximately 50% of the patients develop metastases with limited survival in the course of their disease. For those patients, palliative treatment aiming at symptom relief and improvement of quality of life is most important. However, data on symptom burden and palliative intervention are limited in STS patients. Aim Our study evaluates the effectiveness of a palliative care intervention on symptom relief and quality of life in STS patients. Design/setting We retrospectively analysed 53 inpatient visits of 34 patients with advanced STS, admitted to our palliative care unit between 2012 and 2018. Symptom burden was measured with a standardised base assessment questionnaire at admission and discharge. Results Median disease duration before admission was 24 months, 85% of patients had metastases. The predominant indication for admission was pain, weakness and fatigue. Palliative care intervention led to a significant reduction of pain: median NRS for acute pain was reduced from 3 to 1 (p < 0.001), pain within the last 24 h from 5 to 2 (p < 0.001) and of the median MIDOS symptom score: 18 to 13 (p < 0.001). Also, the median stress level, according to the distress thermometer, was reduced significantly: 7.5 to 5 (p = 0.027). Conclusions Our data underline that specialised palliative care intervention leads to significant symptom relief in patients with advanced STS. Further efforts should aim for an early integration of palliative care in these patients focusing primarily on the identification of subjects at high risk for severe symptomatic disease.

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Section: Discussionsupporting

confidence: 60%

Impact of a specialised palliative care intervention in patients with advanced soft tissue sarcoma – a single-centre retrospective analysis

et al. 2021

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“…Indeed, the authors found that doctors would be more willing to prescribe PC if the term could be avoided [ 36 ]. In France, the ongoing EPIC multicenter randomized clinical trial was launched in 2017 [ 38 ]. Aiming primarily to assess the benefits of early PC access in patients with upper gastrointestinal tract cancers, with a secondary aim of comparing results with those reported in recent highly regarded studies [ 10 – 12 ], EPIC could provide encouraging findings to promote the early-integration model of PC in French hospitals.…”

Section: Discussionmentioning

confidence: 99%

Access to inpatient palliative care among cancer patients in France: an analysis based on the national cancer cohort

Janah

Bihan-Benjamin

Mancini

et al. 2020

BMC Health Serv Res

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Background Closely linked to the concept of supportive care, the integrated model of palliative care (PC) implies identifying, assessing and treating physical and psychological suffering as early as needed, irrespective of patient characteristics. In France, as in the most southern European countries, little is known about the proportion of cancer patients who have access to PC. Accordingly, we aimed in this study to estimate the proportion of cancer patients in France who have access to inpatient PC, and to explore associated factors. We carried out a nationwide retrospective cohort study using data from the French national health system database (SNDS) for all individuals diagnosed with cancer in 2013 and followed between 2013 and 2016. We compared patients who had inpatient PC with those who did not. Results Of the 313,059 cancer patients included in the national French cancer cohort in 2013, 53,437 (17%) accessed inpatient PC at least once between 2013 and 2016, ranging from 2% in survivors to 56% in the deceased population. Multivariate logistic regression revealed that women and younger patients (18–49 years old) were less likely to access inpatient PC while patients with a greater number of comorbidities, metastatic cancer, or cancer of the nervous system, were more likely to have done so. Conclusions A negligible proportion of cancer survivors accessed inpatient PC. More research and training are needed to convince healthcare providers, patients, and families about the substantial benefits of PC, and to promote better integration of PC and oncology.

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“…Although the primary outcome was not met, this trial showed promising findings that EPC may improve early pain relief for patients with advanced pancreatobiliary cancers, compared to usual oncologic care. An ongoing randomized controlled trial is testing the hypothesis that EPC may benefit patients with metastatic upper gastrointestinal cancers, including PC and BTC, treated with first-line chemotherapy [34]. Further research may help to design a strategy to implement EPC compatible with current health service provisions for patients with pancreatobiliary cancers.…”

Section: Discussionmentioning

confidence: 99%

Effect of Early Management on Pain and Depression in Patients with Pancreatobiliary Cancer: A Randomized Clinical Trial

Woo

Song

Lee

et al. 2019

Cancers

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Background: The present study assessed whether early palliative care (EPC) targeting pain and depression and automated symptom monitoring could improve symptoms in patients with advanced pancreatobiliary cancer. Methods: Patients diagnosed with pathologically confirmed locally advanced or metastatic pancreatic or biliary tract cancer who had cancer-related pain (brief pain inventory (BPI) worst pain score >3) and/or depression (Center for Epidemiological Studies—Depression Scale (CES-D) >16) were randomized within 8 weeks after diagnosis to receive EPC or on-demand palliative care (n = 144 each). EPC included (1) nursing assessment of pain and depression, (2) pain control based on National Comprehensive Cancer Network guidelines, (3) depression control by psychoeducation and/or consultation with a psychiatric specialist, and (4) patient education. The primary end points were ≥50% reductions from baseline to week 4 in pain and depression scores. Results: The proportion of patients in the EPC and usual care groups with ≥50% reductions in pain (29.5% vs. 25.2%; p = 0.4194) and depression (30.8% vs. 36.8%; p = 0.5732) scores from baseline to week 4 did not differ significantly. The proportion of patients with BPI worst pain score ≤3 was significantly higher (51.1% vs. 38.9%, p = 0.0404) and the reduction in pain intensity score significantly greater (1.5 vs. 1.0 points, p = 0.0318) in the EPC than in the usual care group. At 4 weeks, patients in the EPC group reported significant increases in global health status, role of functioning, nausea and vomiting, and pain scores on the European Organization for Research and Treatment of Cancer Core Quality of Life questionnaire (EORTC QLQ-C30) general questionnaire. Conclusions: Although the primary outcome was not met, this trial indicates that EPC may improve early pain relief in patients with advanced pancreatobiliary cancers.

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Impact of early palliative care on overall survival of patients with metastatic upper gastrointestinal cancers treated with first-line chemotherapy: a randomised phase III trial

Cited by 13 publications

References 16 publications

Impact of a specialised palliative care intervention in patients with advanced soft tissue sarcoma – a single-centre retrospective analysis

Impact of a specialised palliative care intervention in patients with advanced soft tissue sarcoma – a single-centre retrospective analysis

Access to inpatient palliative care among cancer patients in France: an analysis based on the national cancer cohort

Effect of Early Management on Pain and Depression in Patients with Pancreatobiliary Cancer: A Randomized Clinical Trial

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