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Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial

IMPORTANCE: Involvement of palliative care specialists in the care of medical oncology patients has been repeatedly observed to improve patient-reported outcomes, but there is no analogous research in surgical oncology populations. OBJECTIVE: To determine whether surgeon–palliative care team comanag...

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Autores principales: Aslakson, Rebecca A., Rickerson, Elizabeth, Fahy, Bridget, Waterman, Brittany, Siden, Rachel, Colborn, Kathryn, Smith, Shelby, Verano, Mae, Lira, Isaac, Hollahan, Caroline, Siddiqi, Amn, Johnson, Kemba, Chandrashekaran, Shivani, Harris, Elizabeth, Nudotor, Richard, Baker, Joshua, Heidari, Shireen N., Poultsides, George, Conca-Cheng, Alison M., Cook Chapman, Allyson, Lessios, Anna Sophia, Holdsworth, Laura M., Gustin, Jillian, Ejaz, Aslam, Pawlik, Timothy, Miller, Judi, Morris, Arden M., Tulsky, James A., Lorenz, Karl, Temel, Jennifer S., Smith, Thomas J., Johnston, Fabian
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Medical Association 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10233417/
https://www.ncbi.nlm.nih.gov/pubmed/37256623
http://dx.doi.org/10.1001/jamanetworkopen.2023.14660
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author Aslakson, Rebecca A.
Rickerson, Elizabeth
Fahy, Bridget
Waterman, Brittany
Siden, Rachel
Colborn, Kathryn
Smith, Shelby
Verano, Mae
Lira, Isaac
Hollahan, Caroline
Siddiqi, Amn
Johnson, Kemba
Chandrashekaran, Shivani
Harris, Elizabeth
Nudotor, Richard
Baker, Joshua
Heidari, Shireen N.
Poultsides, George
Conca-Cheng, Alison M.
Cook Chapman, Allyson
Lessios, Anna Sophia
Holdsworth, Laura M.
Gustin, Jillian
Ejaz, Aslam
Pawlik, Timothy
Miller, Judi
Morris, Arden M.
Tulsky, James A.
Lorenz, Karl
Temel, Jennifer S.
Smith, Thomas J.
Johnston, Fabian
author_facet Aslakson, Rebecca A.
Rickerson, Elizabeth
Fahy, Bridget
Waterman, Brittany
Siden, Rachel
Colborn, Kathryn
Smith, Shelby
Verano, Mae
Lira, Isaac
Hollahan, Caroline
Siddiqi, Amn
Johnson, Kemba
Chandrashekaran, Shivani
Harris, Elizabeth
Nudotor, Richard
Baker, Joshua
Heidari, Shireen N.
Poultsides, George
Conca-Cheng, Alison M.
Cook Chapman, Allyson
Lessios, Anna Sophia
Holdsworth, Laura M.
Gustin, Jillian
Ejaz, Aslam
Pawlik, Timothy
Miller, Judi
Morris, Arden M.
Tulsky, James A.
Lorenz, Karl
Temel, Jennifer S.
Smith, Thomas J.
Johnston, Fabian
author_sort Aslakson, Rebecca A.
collection PubMed
description IMPORTANCE: Involvement of palliative care specialists in the care of medical oncology patients has been repeatedly observed to improve patient-reported outcomes, but there is no analogous research in surgical oncology populations. OBJECTIVE: To determine whether surgeon–palliative care team comanagement, compared with surgeon team alone management, improves patient-reported perioperative outcomes among patients pursuing curative-intent surgery for high morbidity and mortality upper gastrointestinal (GI) cancers. DESIGN, SETTING, AND PARTICIPANTS: From October 20, 2018, to March 31, 2022, a patient-randomized clinical trial was conducted with patients and clinicians nonblinded but the analysis team blinded to allocation. The trial was conducted in 5 geographically diverse academic medical centers in the US. Individuals pursuing curative-intent surgery for an upper GI cancer who had received no previous specialist palliative care were eligible. Surgeons were encouraged to offer participation to all eligible patients. INTERVENTION: Surgeon–palliative care comanagement patients met with palliative care either in person or via telephone before surgery, 1 week after surgery, and 1, 2, and 3 months after surgery. For patients in the surgeon-alone group, surgeons were encouraged to follow National Comprehensive Cancer Network–recommended triggers for palliative care consultation. MAIN OUTCOMES AND MEASURES: The primary outcome of the trial was patient-reported health-related quality of life at 3 months following the operation. Secondary outcomes were patient-reported mental and physical distress. Intention-to-treat analysis was performed. RESULTS: In total, 359 patients (175 [48.7%] men; mean [SD] age, 64.6 [10.7] years) were randomized to surgeon-alone (n = 177) or surgeon–palliative care comanagement (n = 182), with most patients (206 [57.4%]) undergoing pancreatic cancer surgery. No adverse events were associated with the intervention, and 11% of patients in the surgeon-alone and 90% in the surgeon–palliative care comanagement groups received palliative care consultation. There was no significant difference between study arms in outcomes at 3 months following the operation in patient-reported health-related quality of life (mean [SD], 138.54 [28.28] vs 136.90 [28.96]; P = .62), mental health (mean [SD], −0.07 [0.87] vs −0.07 [0.84]; P = .98), or overall number of deaths (6 [3.7%] vs 7 [4.1%]; P > .99). CONCLUSIONS AND RELEVANCE: To date, this is the first multisite randomized clinical trial to evaluate perioperative palliative care and the earliest integration of palliative care into cancer care. Unlike in medical oncology practice, the data from this trial do not suggest palliative care–associated improvements in patient-reported outcomes among patients pursuing curative-intent surgeries for upper GI cancers. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03611309
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spelling pubmed-102334172023-06-02 Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial Aslakson, Rebecca A. Rickerson, Elizabeth Fahy, Bridget Waterman, Brittany Siden, Rachel Colborn, Kathryn Smith, Shelby Verano, Mae Lira, Isaac Hollahan, Caroline Siddiqi, Amn Johnson, Kemba Chandrashekaran, Shivani Harris, Elizabeth Nudotor, Richard Baker, Joshua Heidari, Shireen N. Poultsides, George Conca-Cheng, Alison M. Cook Chapman, Allyson Lessios, Anna Sophia Holdsworth, Laura M. Gustin, Jillian Ejaz, Aslam Pawlik, Timothy Miller, Judi Morris, Arden M. Tulsky, James A. Lorenz, Karl Temel, Jennifer S. Smith, Thomas J. Johnston, Fabian JAMA Netw Open Original Investigation IMPORTANCE: Involvement of palliative care specialists in the care of medical oncology patients has been repeatedly observed to improve patient-reported outcomes, but there is no analogous research in surgical oncology populations. OBJECTIVE: To determine whether surgeon–palliative care team comanagement, compared with surgeon team alone management, improves patient-reported perioperative outcomes among patients pursuing curative-intent surgery for high morbidity and mortality upper gastrointestinal (GI) cancers. DESIGN, SETTING, AND PARTICIPANTS: From October 20, 2018, to March 31, 2022, a patient-randomized clinical trial was conducted with patients and clinicians nonblinded but the analysis team blinded to allocation. The trial was conducted in 5 geographically diverse academic medical centers in the US. Individuals pursuing curative-intent surgery for an upper GI cancer who had received no previous specialist palliative care were eligible. Surgeons were encouraged to offer participation to all eligible patients. INTERVENTION: Surgeon–palliative care comanagement patients met with palliative care either in person or via telephone before surgery, 1 week after surgery, and 1, 2, and 3 months after surgery. For patients in the surgeon-alone group, surgeons were encouraged to follow National Comprehensive Cancer Network–recommended triggers for palliative care consultation. MAIN OUTCOMES AND MEASURES: The primary outcome of the trial was patient-reported health-related quality of life at 3 months following the operation. Secondary outcomes were patient-reported mental and physical distress. Intention-to-treat analysis was performed. RESULTS: In total, 359 patients (175 [48.7%] men; mean [SD] age, 64.6 [10.7] years) were randomized to surgeon-alone (n = 177) or surgeon–palliative care comanagement (n = 182), with most patients (206 [57.4%]) undergoing pancreatic cancer surgery. No adverse events were associated with the intervention, and 11% of patients in the surgeon-alone and 90% in the surgeon–palliative care comanagement groups received palliative care consultation. There was no significant difference between study arms in outcomes at 3 months following the operation in patient-reported health-related quality of life (mean [SD], 138.54 [28.28] vs 136.90 [28.96]; P = .62), mental health (mean [SD], −0.07 [0.87] vs −0.07 [0.84]; P = .98), or overall number of deaths (6 [3.7%] vs 7 [4.1%]; P > .99). CONCLUSIONS AND RELEVANCE: To date, this is the first multisite randomized clinical trial to evaluate perioperative palliative care and the earliest integration of palliative care into cancer care. Unlike in medical oncology practice, the data from this trial do not suggest palliative care–associated improvements in patient-reported outcomes among patients pursuing curative-intent surgeries for upper GI cancers. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03611309 American Medical Association 2023-05-31 /pmc/articles/PMC10233417/ /pubmed/37256623 http://dx.doi.org/10.1001/jamanetworkopen.2023.14660 Text en Copyright 2023 Aslakson RA et al. JAMA Network Open. https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the CC-BY License.
spellingShingle Original Investigation
Aslakson, Rebecca A.
Rickerson, Elizabeth
Fahy, Bridget
Waterman, Brittany
Siden, Rachel
Colborn, Kathryn
Smith, Shelby
Verano, Mae
Lira, Isaac
Hollahan, Caroline
Siddiqi, Amn
Johnson, Kemba
Chandrashekaran, Shivani
Harris, Elizabeth
Nudotor, Richard
Baker, Joshua
Heidari, Shireen N.
Poultsides, George
Conca-Cheng, Alison M.
Cook Chapman, Allyson
Lessios, Anna Sophia
Holdsworth, Laura M.
Gustin, Jillian
Ejaz, Aslam
Pawlik, Timothy
Miller, Judi
Morris, Arden M.
Tulsky, James A.
Lorenz, Karl
Temel, Jennifer S.
Smith, Thomas J.
Johnston, Fabian
Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial
title Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial
title_full Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial
title_fullStr Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial
title_full_unstemmed Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial
title_short Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer: A Randomized Clinical Trial
title_sort effect of perioperative palliative care on health-related quality of life among patients undergoing surgery for cancer: a randomized clinical trial
topic Original Investigation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10233417/
https://www.ncbi.nlm.nih.gov/pubmed/37256623
http://dx.doi.org/10.1001/jamanetworkopen.2023.14660
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