A randomized trial of oncology nurse-led palliative care did not improve patient-reported outcomes after 3 months.
For patients with advanced cancer, there is one significant impairment most aspects of their quality of life. A holistic approach to cancer care should pay some attention to a patient’s emotional needs as many of those who have cancer are Depression or anxiety as the central symptom. Research suggests, however, that the proportion of doctor-patient consultations devoted to quality of life issues is at limited although nurse-led palliative care has been shown to be too Improvements in the patient’s quality of life.
To further strengthen the evidence base for the value of nurse-led palliative care, a team from the Palliative Research Center at the University of Pittsburgh, USA, developed Care Management by Oncology Nurses to Address Supportive Care Needs (ASSOCIATE) intervene. While the pilot study found high levels of satisfaction with the intervention, it lacked a control arm, and this led the team to decide to examine the effects of the CONNECT intervention versus standard oncology care in patients with advanced cancers. For the purposes of the study, patients with advanced, metastatic solid tumors were defined as patients for whom the oncologist stated “wouldn’t be surprised if the patient died next year“.
Enrolled patients were randomly assigned to the CONNECT intervention or standard oncological care, which was defined as the best oncological care. Patients randomized to the CONNECT arm received a monthly visit from a trained oncology nurse over a three month period, and the intervention itself was based on that Chronic care model. Three primary outcomes were used and designed to assess the quality of life used and completed at baseline and after three months. The first was the Functional Assessment of Chronic Disease Therapy-Palliative Care (FACIT-Pal), with higher values indicating a better quality of life. The second symptom severity assessed using the Edmonton Symptom Assessment Scale (ESAS), for which higher values reflect a greater burden of symptoms. The final measure was the Hospital Anxiety and Depression Scale (HADS), with higher scores indicating higher levels of anxiety and depression.
A total of 672 patients with an average age of 69.3 years (53.6% female) were randomized to the CONNECT palliative intervention (336) or standard care. The two most common cancers were lung cancer (36%) and gastrointestinal cancer (19.5%). For CONNECT patients, the mean number of completed visits was 2.2 and 56% of patients received 3 visits. There were no significant differences with regard to the 3-month changes in the three endpoints. For example, the mean FACIT-Pal scores were 130.7 and 134.1 (CONNECT vs. standard care, adjusted mean difference = 1.20, p = 0.55). There were also no differences in the ESAS (adjusted mean difference = -.2.46, p = 0.11) or HADS scores.
The authors concluded that more work is needed to identify effective palliative care treatments for patients with advanced cancer.
Schenker Y et al. Effect of an oncology nurse-led primary palliative care intervention on patients with advanced cancer. The CONNECT Cluster randomized clinical trial. JAMA Int Med 2021