Effect of Perioperative Palliative Care on Health-Related Quality of Life Among Patients Undergoing Surgery for Cancer

Key Points Question Does proactive specialist palliative care improve patient-reported outcomes in patients receiving curative-intent surgeries for high morbidity and mortality upper gastrointestinal cancers? Findings In this randomized clinical trial across 5 geographically diverse cancer centers that included 356 adults randomized to either surgeon alone or surgeon–palliative care team comanagement, there was no significant difference in postoperative patient-reported outcomes, such as quality of life or mental health. Palliative care was well tolerated by study patient and practitioner participants with no associated harms. Meaning Data from this study do not suggest benefits with palliative care for surgical oncology patients with newly diagnosed cancers who were pursuing curative-intent operations; integration of palliative care specialists could possibly be more effectively targeted toward patients with poorer baseline quality of life and functionality.

[1]  M. Ychou,et al.  Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer: A Randomized Clinical Trial. , 2022, JAMA oncology.

[2]  J. Temel,et al.  Integrated Palliative and Oncology Care for Patients With Acute Myeloid Leukemia-Moving From Evidence to Practice-Reply. , 2021, JAMA oncology.

[3]  J. Hanmer,et al.  Computing PROPr Utility Scores for PROMIS® Profile Instruments. , 2020, Value in health : the journal of the International Society for Pharmacoeconomics and Outcomes Research.

[4]  A. Morris,et al.  Palliative Care and End-of-Life Outcomes Following High-Risk Surgery. , 2020, JAMA surgery.

[5]  Thomas J. Smith,et al.  A Multicenter, Randomized Controlled Trial of Perioperative Palliative Care Surrounding Cancer Surgery for Patients and Their Family Members (PERIOP-PC). , 2019, Journal of palliative medicine.

[6]  Thomas J. Smith,et al.  Integrating Advance Care Planning Videos into Surgical Oncologic Care: A Randomized Clinical Trial. , 2019, Journal of palliative medicine.

[7]  M. King,et al.  Assessing quality of life in palliative care settings: head-to-head comparison of four patient-reported outcome measures (EORTC QLQ-C15-PAL, FACT-Pal, FACT-Pal-14, FACT-G7) , 2019, Supportive Care in Cancer.

[8]  Thierry Lecomte,et al.  FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer , 2018, The New England journal of medicine.

[9]  D. Meier,et al.  National Consensus Project Clinical Practice Guidelines for Quality Palliative Care Guidelines, 4th Edition. , 2018, Journal of palliative medicine.

[10]  R. Hays,et al.  PROMIS®-29 v2.0 profile physical and mental health summary scores , 2018, Quality of Life Research.

[11]  Thomas J. Smith,et al.  Family companions' involvement during pre-surgical consent visits for major cancer surgery and its relationship to visit communication and satisfaction. , 2018, Patient Education and Counseling.

[12]  Thomas J. Smith,et al.  An advance care plan decision support video before major surgery: a patient- and family-centred approach , 2018, BMJ Supportive & Palliative Care.

[13]  L. Traeger,et al.  Effect of Inpatient Palliative Care During Hematopoietic Stem-Cell Transplant on Psychological Distress 6 Months After Transplant: Results of a Randomized Clinical Trial. , 2017, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[14]  E. Salsberg,et al.  The 2015 Class of Hospice and Palliative Medicine Fellows-From Training to Practice: Implications for HPM Workforce Supply. , 2017, Journal of pain and symptom management.

[15]  A. Darzi,et al.  The psychological impact of symptoms related to esophagogastric cancer resection presenting in primary care: A national linked database study. , 2017, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[16]  L. Traeger,et al.  Effect of Inpatient Palliative Care on Quality of Life 2 Weeks After Hematopoietic Stem Cell Transplantation: A Randomized Clinical Trial. , 2016, JAMA.

[17]  S. Morton,et al.  Association Between Palliative Care and Patient and Caregiver Outcomes , 2016 .

[18]  A. Bader,et al.  Palliative Care Interventions for Surgical Patients: A Systematic Review. , 2016, JAMA surgery.

[19]  A. Rajput,et al.  Utilization of palliative care consultation service by surgical services. , 2015, Annals of palliative medicine.

[20]  R. Morrison,et al.  Palliative Care for the Seriously Ill. , 2015, The New England journal of medicine.

[21]  K. Smith,et al.  Why don't end-of-life conversations go viral? A review of videos on YouTube , 2015, BMJ Supportive & Palliative Care.

[22]  J. Cameron,et al.  Two thousand consecutive pancreaticoduodenectomies. , 2015, Journal of the American College of Surgeons.

[23]  M. Mckneally,et al.  "And I think that we can fix it": mental models used in high-risk surgical decision making. , 2015, Annals of surgery.

[24]  Mark T Hegel,et al.  Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial. , 2015, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[25]  N. Altorki,et al.  Outcomes in the management of esophageal cancer , 2014, Journal of surgical oncology.

[26]  D. Malone,et al.  Pancreaticoduodenectomy: expected post-operative anatomy and complications. , 2014, The British journal of radiology.

[27]  M. Mckneally,et al.  It's Big Surgery: Preoperative Expressions of Risk, Responsibility, and Commitment to Treatment After High-Risk Operations , 2014, Annals of surgery.

[28]  G. Alexander,et al.  Surgeons Expect Patients to Buy-In to Postoperative Life Support Preoperatively: Results of a National Survey* , 2013, Critical care medicine.

[29]  H. Pitt,et al.  Risk of Morbidity and Mortality Following Hepato-Pancreato-Biliary Surgery , 2012, Journal of Gastrointestinal Surgery.

[30]  R. Heist,et al.  Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[31]  M. Falconi,et al.  Clinical and Patient-Reported Outcomes After Pancreatoduodenectomy for Different Diseases: A Follow-Up Study , 2011, Pancreas.

[32]  D. Lupu Estimate of current hospice and palliative medicine physician workforce shortage. , 2010, Journal of pain and symptom management.

[33]  J. Hunter,et al.  Patient and Peri-operative Predictors of Morbidity and Mortality After Esophagectomy: American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP), 2005–2008 , 2010, Journal of Gastrointestinal Surgery.

[34]  Alona Muzikansky,et al.  Early palliative care for patients with metastatic non-small-cell lung cancer. , 2010, The New England journal of medicine.

[35]  K. Brasel,et al.  Physician attitudes regarding advance directives for high-risk surgical patients: a qualitative analysis. , 2010, Surgery.

[36]  K. Brasel,et al.  Surgical “buy-in”: The contractual relationship between surgeons and patients that influences decisions regarding life-supporting therapy* , 2010, Critical care medicine.

[37]  William Dale,et al.  Age-related trends in utilization and outcome of open and endovascular repair for abdominal aortic aneurysm in the United States, 2001-2006. , 2009, Journal of vascular surgery.

[38]  Mark T Hegel,et al.  Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. , 2009, JAMA.

[39]  J. Birkmeyer,et al.  Outcomes in octogenarians undergoing high-risk cancer operation: a national study. , 2007, Journal of the American College of Surgeons.

[40]  T. Ahles,et al.  Project ENABLE: a palliative care demonstration project for advanced cancer patients in three settings. , 2004, Journal of palliative medicine.

[41]  S. Streat,et al.  Surgeons, intensivists, and the covenant of care: Administrative models and values affecting care at the end of life—Updated§ , 2003, Critical care medicine.

[42]  T. Buchman,et al.  Who should manage the dying patient?: Rescue, shame, and the surgical ICU dilemma. , 2002, Journal of the American College of Surgeons.

[43]  D. Tulsky,et al.  The Functional Assessment of Cancer Therapy scale: development and validation of the general measure. , 1993, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[44]  Thomas J. Smith,et al.  Developing the Storyline for an Advance Care Planning Video for Surgery Patients: Patient-Centered Outcomes Research Engagement from Stakeholder Summit to State Fair. , 2018, Journal of Palliative Medicine.

[45]  J. Kutner,et al.  NCCN Guidelines ® Insights Palliative Care , Version 2 . 2017 Featured Updates to the NCCN Guidelines , 2017 .

[46]  N. Bardeesy,et al.  Pancreatic adenocarcinoma. , 2014, The New England journal of medicine.

[47]  G. Alexander,et al.  Surgeon-reported conflict with intensivists about postoperative goals of care. , 2013, JAMA surgery.

[48]  M. Hegel,et al.  Reliability and validity of the Functional Assessment of Chronic Illness Therapy-Palliative care (FACIT-Pal) scale. , 2009, Journal of pain and symptom management.

[49]  J. Maurino,et al.  Patient Preference and Adherence , 2022 .