The effect of early and systematic integration of palliative care in oncology on quality of life and health care use near the end of life: A randomised controlled trial

Gaëlle Vanbutsele; Simon Van Belle; Veerle Surmont; Martine De Laat; Roos Colman; Kim Eecloo; Eline Naert; Marc De Man; Karen Geboes; Luc Deliens; Koen Pardon

doi:10.1016/j.ejca.2019.11.009

The effect of early and systematic integration of palliative care in oncology on quality of life and health care use near the end of life: A randomised controlled trial

Eur J Cancer. 2020 Jan:124:186-193. doi: 10.1016/j.ejca.2019.11.009. Epub 2019 Dec 5.

Authors

Gaëlle Vanbutsele¹, Simon Van Belle², Veerle Surmont³, Martine De Laat⁴, Roos Colman⁵, Kim Eecloo⁶, Eline Naert⁷, Marc De Man⁸, Karen Geboes⁹, Luc Deliens¹⁰, Koen Pardon¹⁰

Affiliations

¹ End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Belgium; Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Hematology, Ghent University Hospital, Ghent, Belgium. Electronic address: [email protected].
² Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
³ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Respiratory Medicine/Thoracic Oncology, Ghent University Hospital, Ghent, Belgium.
⁴ Palliative Care Team, Ghent University Hospital, Ghent, Belgium.
⁵ Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
⁶ End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Belgium; Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
⁷ Department of Medical Oncology, Ghent University Hospital, Ghent, Belgium.
⁸ Department of Gastroenterology, Division of Digestive Oncology, Ghent University Hospital, Ghent, Belgium.
⁹ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium; Department of Gastroenterology, Division of Digestive Oncology, Ghent University Hospital, Ghent, Belgium.
¹⁰ End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Belgium.

PMID: 31812934
DOI: 10.1016/j.ejca.2019.11.009

Abstract

Purpose: This study evaluated the effect of early integrated palliative care (PC) in oncology on quality of life (QOL) near the end of life and use of health care resources near the end of life.

Method: Patients with advanced cancer and a life expectancy of approximately 1 year were randomly assigned to either early and systematic integration of PC into oncological care (intervention) or standard oncological care alone (control). QOL was assessed with the EORTC QLQ-C30 global health status/QOL scale and McGill Quality of Life (MQOL) Single Item Scale and Summary Scale at baseline, 12 weeks and 6 weekly thereafter until death. Use of health care resources was collected from chart review in patient's electronic medical file for patients who died while participating in the study.

Results: Of the 186 randomised patients, 185 participants had a baseline measurement and were analysed. By November 2017, 128 patients had died while participating in the study. When applying the terminal decline model, patients in the intervention group scored significantly higher on global health status/QOL of the EORTC QLQ C30, at 6 months (difference: 5.9 [0.06; 11.1], p = 0.03), 3 (difference: 6.8 [1.0; 12.6], p = 0.02), and 1 month (difference: 7.6 [0.7; 14.5], p = 0.03) prior to the patient's death compared to the control group. Similar results were found for the Single Item Scale and Summary Score of the MQOL. We did not observe differences in use of health care resources between groups.

Discussion: Early integrated palliative care in oncology is a valuable approach since it also increases QOL near the end of life and not only soon after initiation of PC.

Keywords: Advanced cancer; Early palliative care; End of life; Neoplasm; Patient-centred care; Quality of life.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Female
Humans
Male
Middle Aged
Palliative Care / methods*
Quality of Life / psychology*
Terminal Care / methods*