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Early palliative care and quality of dying and death in patients with advanced cancer
  1. Kenneth Mah1,
  2. Brittany Chow1,
  3. Nadia Swami1,
  4. Ashley Pope1,
  5. Anne Rydall1,
  6. Craig Earle2,3,
  7. Monika Krzyzanowska3,4,
  8. Lisa Le5,
  9. Sarah Hales1,6,
  10. Gary Rodin1,6,7,
  11. Breffni Hannon1,3,8 and
  12. Camilla Zimmermann1,3,6,7,8
  1. 1Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
  2. 2Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  3. 3Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
  5. 5Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
  6. 6Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  7. 7Princess Margaret Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
  8. 8Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Camilla Zimmermann, 12-300 - 620 University Ave, Department of Supportive Care, Princess Margaret Cancer Centre, Toronto, ON M5G 2C1, Canada; camilla.zimmermann{at}uhn.ca

Abstract

Objective Early palliative care (EPC) in the outpatient setting improves quality of life for patients with advanced cancer, but its impact on quality of dying and death (QODD) and on quality of life at the end of life (QOL-EOL) has not been examined. Our study investigated the impact of EPC on patients’ QODD and QOL-EOL and the moderating role of receiving inpatient or home palliative care.

Method Bereaved family caregivers who had provided care for patients participating in a cluster-randomised trial of EPC completed a validated QODD scale and indicated whether patients had received additional home palliative care or care in an inpatient palliative care unit (PCU). We examined the effects of EPC, inpatient or home palliative care, and their interactions on the QODD total score and on QOL-EOL (last 7 days of life).

Results A total of 157 caregivers participated. Receipt of EPC showed no association with QODD total score. However, when additional palliative care was included in the model, intervention patients demonstrated better QOL-EOL than controls (p=0.02). Further, the intervention by PCU interaction was significant (p=0.02): those receiving both EPC and palliative care in a PCU had better QOL-EOL than those receiving only palliative care in a PCU (mean difference=27.10, p=0.002) or only EPC (mean difference=20.59, p=0.02).

Conclusion Although there was no association with QODD, EPC was associated with improved QOL-EOL, particularly for those who also received inpatient care in a PCU. This suggests a long-term benefit from early interdisciplinary palliative care on care throughout the illness.

Trial registration number ClinicalTrials.gov Registry (#NCT01248624).

  • cancer
  • quality of life
  • supportive care
  • terminal care

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Footnotes

  • Contributors All authors contributed to conception and design. AP and NS contributed to acquisition of data. KM completed data analysis and interpreted the data with input from CZ and LL. KM and CZ drafted the article, and all authors reviewed it critically for important intellectual content. All authors approved the final version and have participated sufficiently in the work to take responsibility for appropriate portions of the content.

  • Funding The study was supported by the Canadian Cancer Society (grant #017257, #020509, #700862; CZ), the Canadian Institutes of Health Research (grant #152996; CZ), and the Ontario Ministry of Health and Long-Term Care. CZ is also supported by the Rose Family Chair in Palliative Medicine and Supportive Care, Faculty of Medicine, University of Toronto.

  • Disclaimer The funders of the original trial played no role in the study design, data collection and analysis, data interpretation, or writing of this report.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The EPC trial protocol was approved by the University Health Network Research Ethics Board (REB #06-0525-CE).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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