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PALLiative care in ONcology (PALLiON): A cluster-randomised trial investigating the effect of palliative care on the use of anticancer treatment at the end of life.
- Source :
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Palliative medicine [Palliat Med] 2024 Feb; Vol. 38 (2), pp. 229-239. Date of Electronic Publication: 2024 Jan 09. - Publication Year :
- 2024
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Abstract
- Background: Effects on anticancer therapy following the integration of palliative care and oncology are rarely investigated. Thus, its potential effect is unknown.<br />Aim: To investigate the effects of the complex intervention PALLiON versus usual care on end-of-life anticancer therapy.<br />Design: Cluster-randomised controlled trial (RCT), registered at ClinicalTrials.gov (No. NCT03088202). The complex intervention consisted of a physician education program enhancing theoretical, clinical and communication skills, a patient-centred care pathway and patient symptom reporting prior to all consultations. Primary outcome was overall use, start and cessation of anticancer therapy in the last 3 months before death. Secondary outcomes were patient-reported outcomes. Mixed effects logistic regression models and Cox proportional hazard were used.<br />Setting: A total of 12 Norwegian hospitals (03/2017-02/2021).<br />Participants: Patients ⩾18 years, advanced stage solid tumour, starting last line of anticancer therapy, estimated life expectancy ⩽12 months.<br />Results: A total of 616 (93%) patients were included (intervention: 309/control:307); 63% males, median age 69, 77% had gastrointestinal cancers. Median survival time from inclusion was 8 (IQR 3-14) and 7 months (IQR 3-12), and days between anticancer therapy start and death were 204 (90-378) and 168 (69-351) (intervention/control). Overall, 78 patients (13%) received anticancer therapy in the last month (intervention: 33 [11%]/control: 45 [15%]). No differences were found in patient-reported outcomes.<br />Conclusion: We found no significant differences in the probability of receiving end-of-life anticancer therapy. The intervention did not have the desired effect. It was probably too general and too focussed on communication skills to exert a substantial influence on conventional clinical practice.<br />Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Details
- Language :
- English
- ISSN :
- 1477-030X
- Volume :
- 38
- Issue :
- 2
- Database :
- MEDLINE
- Journal :
- Palliative medicine
- Publication Type :
- Academic Journal
- Accession number :
- 38193250
- Full Text :
- https://doi.org/10.1177/02692163231222391