PT  - JOURNAL ARTICLE
AU  - Kenneth Mah
AU  - Brittany Chow
AU  - Nadia Swami
AU  - Ashley Pope
AU  - Anne Rydall
AU  - Craig Earle
AU  - Monika Krzyzanowska
AU  - Lisa Le
AU  - Sarah Hales
AU  - Gary Rodin
AU  - Breffni Hannon
AU  - Camilla Zimmermann
TI  - Early palliative care and quality of dying and death in patients with advanced cancer
AID  - 10.1136/bmjspcare-2021-002893
DP  - 2021 Feb 22
TA  - BMJ Supportive & Palliative Care
PG  - bmjspcare-2021-002893
4099  - http://spcare.bmj.com/content/early/2021/02/22/bmjspcare-2021-002893.short
4100  - http://spcare.bmj.com/content/early/2021/02/22/bmjspcare-2021-002893.full
AB  - 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).