학술논문
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.
Document Type
Article
Author
Hjermstad, Marianne Jensen; Pirnat, Aleksandra; Aass, Nina; Andersen, Sigve; Astrup, Guro L; Dajani, Olav; Garresori, Herish; Guldhav, Kristin V; Hamre, Hanne; Haukland, Ellinor C; Jordal, Frode; Lundeby, Tonje; Løhre, Erik Torbjorn; Mjåland, Svein; Paulsen, Ørnulf; Semb, Karin A; Staff, Erik S; Wester, Torunn; Kaasa, Stein
Source
Subject
*THERAPEUTIC use of antineoplastic agents
*CANCER patient psychology
*SPECIALTY hospitals
*CANCER chemotherapy
*TERMINALLY ill
*PATIENT-centered care
*HEALTH outcome assessment
*TREATMENT effectiveness
*RANDOMIZED controlled trials
*COMPARATIVE studies
*CANCER treatment
*RESEARCH funding
*DESCRIPTIVE statistics
*QUALITY of life
*TUMORS
*DRUG utilization
*STATISTICAL sampling
*TERMINATION of treatment
*LOGISTIC regression analysis
*DEATH
*PALLIATIVE treatment
*IMMUNOTHERAPY
*ONCOLOGISTS
*COMMUNICATION education
*PROPORTIONAL hazards models
*SYMPTOMS
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Language
ISSN
0269-2163
Abstract
Background: Effects on anticancer therapy following the integration of palliative care and oncology are rarely investigated. Thus, its potential effect is unknown. Aim: To investigate the effects of the complex intervention PALLiON versus usual care on end-of-life anticancer therapy. Design: Cluster-randomised controlled trial (RCT), registered at ClinicalTrials.gov (No. NCT01362816). 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. Setting: A total of 12 Norwegian hospitals (03/2017–02/2021). Participants: Patients ⩾18 years, advanced stage solid tumour, starting last line of anticancer therapy, estimated life expectancy ⩽12 months. 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. 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. [ABSTRACT FROM AUTHOR]