Results from randomized controlled trials do not support the routine inclusion of specialized palliative care in patients undergoing major cancer surgery with curative intent.
This trial showed no significant benefit of preoperative consultation with a palliative care specialist for patients undergoing major nonpalliative cancer surgery.
According to researchers led by Myrick Shinall Jr., M.D., Ph.D., Vanderbilt University, the primary outcome, physical and functional quality of life (QoL) at 90 days, was significantly higher in patients who received preoperative palliative care than those who did not. was almost identical among the patients. University Medical Center in Nashville, Tennessee.
This article was published online on May 10. JAMA surgery.
The findings may seem counterintuitive, given that specialist palliative care initiated at the same time as chemotherapy has been shown to improve quality of life.
In an editorial published alongside the study, Shinall et al. “provide a pause to reconsider the role of regular perioperative palliative care consultations in surgical oncology for curative purposes.” He explained.
But editorial writers, led by Jason Michael Johanning, M.D., of the University of Nebraska Medical Center in Omaha, argue that it is premature to deny palliative care to surgical oncologic patients. “Their study helps clarify important questions that should be addressed in further research rather than throwing babies out with the bath water.”
The SCOPE trial enrolled 235 adults scheduled to undergo major surgery for the cure or permanent control of abdominal cancer at an academic center in Tennessee. Overall, patients had a mean age of 65 years and 60% were male.
Patients were randomly assigned to early palliative care intervention or usual care. Palliative care included a preoperative consultation with a palliative care specialist and postoperative inpatient and outpatient palliative care follow-up for her 90 days. Investigators assessed QoL using the Cancer Care Overall Functional Assessment (FACT-G) Trial Outcome Index (TOI). The TOI is scored from 0 to 56, with higher scores representing higher physical and functional QoL.
As a result, no significant difference was found between the intervention group and the usual care group in physical and functional QoL 90 days after surgery. His adjusted median FACT-G TOI score was 46.77 for palliative care interventions and 46.23 for usual care (P = .46).
Compared with usual care, early palliative care also did not improve the overall QoL secondary outcome (odds ratio). [OR]1.09), home survival to 90 postoperative days (OR, 0.87), or 1-year overall survival (hazard ratio, 0.97).
“Given the strength of the study, the most likely explanation for these results is that this intervention does not improve outcomes in this patient population,” the authors write.
However, the authors and editors questioned whether certain patients could still benefit from palliative care.
“Some of these patients may have more needs and benefit from professional palliative care, and the lack of side effects demonstrated in this study is a good indication that professional palliative care It should reassure the referring clinician that is unlikely to afflict or harm patients,” the researchers wrote.
The researchers suggest that future studies will consider surgical populations with a high symptom burden, such as patients undergoing organ transplants, who may benefit from expert palliative care. .
The editors said, “The surgical community should now focus on selecting the best patients, who and when to provide the best palliative care support, and how to best measure the impact of palliative care delivery in the surgical setting.” It is.”
Funding for this study was provided by the National Institutes of Health. The authors did not report any relevant financial relationships. Editorial Writer Johanning reported on a pending patent for FUTUREASSURE.
JAMA Surge. Published online May 10, 2023.summary, editorial
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