Phase II Trial of Symptom Screening With Targeted Early Palliative Care for Patients With Advanced Cancer.

Early Detection of Cancer Humans Neoplasms / diagnosis Palliative Care Patient Reported Outcome Measures Quality of Life

Journal

Journal of the National Comprehensive Cancer Network : JNCCN
ISSN: 1540-1413
Titre abrégé: J Natl Compr Canc Netw
Pays: United States
ID NLM: 101162515

Informations de publication

Date de publication:
07 09 2021
Historique:
received: 04 11 2020
accepted: 24 12 2020
pubmed: 8 9 2021
medline: 13 4 2022
entrez: 7 9 2021
Statut: epublish

Résumé

Routine early palliative care (EPC) improves quality of life (QoL) for patients with advanced cancer, but it may not be necessary for all patients. We assessed the feasibility of Symptom screening with Targeted Early Palliative care (STEP) in a phase II trial. Patients with advanced cancer were recruited from medical oncology clinics. Symptoms were screened at each visit using the Edmonton Symptom Assessment System-revised (ESAS-r); moderate to severe scores (screen-positive) triggered an email to a palliative care nurse, who called the patient and offered EPC. Patient-reported outcomes of QoL, depression, symptom control, and satisfaction with care were measured at baseline and at 2, 4, and 6 months. The primary aim was to determine feasibility, according to predefined criteria. Secondary aims were to assess whether STEP identified patients with worse patient-reported outcomes and whether screen-positive patients who accepted and received EPC had better outcomes over time than those who did not receive EPC. In total, 116 patients were enrolled, of which 89 (77%) completed screening for ≥70% of visits. Of the 70 screen-positive patients, 39 (56%) received EPC during the 6-month study and 4 (6%) received EPC after the study end. Measure completion was 76% at 2 months, 68% at 4 months, and 63% at 6 months. Among screen-negative patients, QoL, depression, and symptom control were substantially better than for screen-positive patients at baseline (all P<.0001) and remained stable over time. Among screen-positive patients, mood and symptom control improved over time for those who accepted and received EPC and worsened for those who did not receive EPC (P<.01 for trend over time), with no difference in QoL or satisfaction with care. STEP is feasible in ambulatory patients with advanced cancer and distinguishes between patients who remain stable without EPC and those who benefit from targeted EPC. Acceptance of the triggered EPC visit should be encouraged. gov identifier: NCT04044040.

Sections du résumé

BACKGROUND
Routine early palliative care (EPC) improves quality of life (QoL) for patients with advanced cancer, but it may not be necessary for all patients. We assessed the feasibility of Symptom screening with Targeted Early Palliative care (STEP) in a phase II trial.
METHODS
Patients with advanced cancer were recruited from medical oncology clinics. Symptoms were screened at each visit using the Edmonton Symptom Assessment System-revised (ESAS-r); moderate to severe scores (screen-positive) triggered an email to a palliative care nurse, who called the patient and offered EPC. Patient-reported outcomes of QoL, depression, symptom control, and satisfaction with care were measured at baseline and at 2, 4, and 6 months. The primary aim was to determine feasibility, according to predefined criteria. Secondary aims were to assess whether STEP identified patients with worse patient-reported outcomes and whether screen-positive patients who accepted and received EPC had better outcomes over time than those who did not receive EPC.
RESULTS
In total, 116 patients were enrolled, of which 89 (77%) completed screening for ≥70% of visits. Of the 70 screen-positive patients, 39 (56%) received EPC during the 6-month study and 4 (6%) received EPC after the study end. Measure completion was 76% at 2 months, 68% at 4 months, and 63% at 6 months. Among screen-negative patients, QoL, depression, and symptom control were substantially better than for screen-positive patients at baseline (all P<.0001) and remained stable over time. Among screen-positive patients, mood and symptom control improved over time for those who accepted and received EPC and worsened for those who did not receive EPC (P<.01 for trend over time), with no difference in QoL or satisfaction with care.
CONCLUSIONS
STEP is feasible in ambulatory patients with advanced cancer and distinguishes between patients who remain stable without EPC and those who benefit from targeted EPC. Acceptance of the triggered EPC visit should be encouraged.
CLINICALTRIALS
gov identifier: NCT04044040.

Identifiants

DOI: 10.6004/jnccn.2020.7803 PMID: 34492632
pubmed: 34492632
doi: 10.6004/jnccn.2020.7803
pii: jnccn20601
doi:
pii:

Banques de données

ClinicalTrials.gov
['NCT04044040']

Types de publication

Clinical Trial, Phase II Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

361-370.e3

Auteurs

Camilla Zimmermann (C)

1Department of Supportive Care, and.
2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
3Division of Medical Oncology.
4Division of Palliative Medicine, Department of Medicine, and.
5Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto.

Ashley Pope (A)

1Department of Supportive Care, and.

Breffni Hannon (B)

1Department of Supportive Care, and.
2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
4Division of Palliative Medicine, Department of Medicine, and.

Monika K Krzyzanowska (MK)

2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
3Division of Medical Oncology.
6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto.

Gary Rodin (G)

1Department of Supportive Care, and.
2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
5Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto.

Madeline Li (M)

1Department of Supportive Care, and.
2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
5Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto.

Doris Howell (D)

1Department of Supportive Care, and.
2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
7Faculty of Nursing, University of Toronto, Toronto.

Jennifer J Knox (JJ)

2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
3Division of Medical Oncology.
6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto.

Natasha B Leighl (NB)

2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
3Division of Medical Oncology.
6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto.

Srikala Sridhar (S)

2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
3Division of Medical Oncology.
6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto.

Amit M Oza (AM)

2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
3Division of Medical Oncology.
6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto.

Rebecca Prince (R)

2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
3Division of Medical Oncology.
6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto.

Stephanie Lheureux (S)

2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
3Division of Medical Oncology.
6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto.

Aaron R Hansen (AR)

2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
3Division of Medical Oncology.
6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto.

Anne Rydall (A)

1Department of Supportive Care, and.

Brittany Chow (B)

1Department of Supportive Care, and.

Leonie Herx (L)

8Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston.

Christopher M Booth (CM)

9Division of Medical Oncology, Kingston Health Sciences Centre, Kingston.
10Department of Oncology, Queen's University, Kingston.
11Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston; and.

Deborah Dudgeon (D)

9Division of Medical Oncology, Kingston Health Sciences Centre, Kingston.

Neesha Dhani (N)

2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
3Division of Medical Oncology.
6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto.

Geoffrey Liu (G)

2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
3Division of Medical Oncology.
6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto.

Philippe L Bedard (PL)

2Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto.
3Division of Medical Oncology.
6Division of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto.

Jean Mathews (J)

1Department of Supportive Care, and.
4Division of Palliative Medicine, Department of Medicine, and.

Nadia Swami (N)

1Department of Supportive Care, and.

Lisa W Le (LW)

12Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.

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Classifications MeSH

questionsmedicales.fr › Diagnostic › Diagnostic précoce › Dépistage précoce du cancer › Phase II Trial of Symptom Screening With...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Phase II Trial of Symptom Screening With...
questionsmedicales.fr › Tumeurs › Phase II Trial of Symptom Screening With...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Soins aux patients › Soins palliatifs › Phase II Trial of Symptom Screening With...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Collecte de données › Enquêtes et questionnaires › Enquêtes sur les soins de santé › Mesures des résultats rapportés par les patients › Phase II Trial of Symptom Screening With...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Mesures épidémiologiques › Démographie › État de santé › Qualité de vie › Phase II Trial of Symptom Screening With...