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

Autor:	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., Pope A; 1Department of Supportive Care, and., 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., 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., 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., 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., 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., 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., 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., 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., 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., 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., 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., 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., Rydall A; 1Department of Supportive Care, and., Chow B; 1Department of Supportive Care, and., Herx L; 8Division of Palliative Medicine, Department of Medicine, Queen's University, Kingston., 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., Dudgeon D; 9Division of Medical Oncology, Kingston Health Sciences Centre, Kingston., 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., 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., 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., Mathews J; 1Department of Supportive Care, and.; 4Division of Palliative Medicine, Department of Medicine, and., Swami N; 1Department of Supportive Care, and., Le LW; 12Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Jazyk:	angličtina
Zdroj:	Journal of the National Comprehensive Cancer Network : JNCCN [J Natl Compr Canc Netw] 2021 Sep 07; Vol. 20 (4), pp. 361-370.e3. Date of Electronic Publication: 2021 Sep 07.
DOI:	10.6004/jnccn.2020.7803
Abstrakt:	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.
Databáze:	MEDLINE
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