We conducted a cluster‐randomized controlled trial comparing specialized early palliative care to standard oncology care in patients with advanced cancer.
We hypothesized that early palliative care would be associated with greater improvements in quality of life, symptom control, satisfaction with care, and clinician–patient interactions in those with high symptom burden at baseline, compared to those with low symptom burden at baseline.
The aim of the current analysis was to examine whether outcomes of this cluster‐randomized trial differed between subgroups according to symptom severity at baseline. There was no difference between the intervention and standard care arms in difficulties with clinician‐patient interactions. We previously reported on the results of a cluster‐randomized controlled trial that examined the impact of early palliative care provided in a specialized palliative care clinic on multiple patient‐reported outcomes.Ĭompared to those receiving standard oncology care, patients assigned to the early palliative care group had improved quality of life, symptom control, and satisfaction with care 4 months after randomization. Further, automatic triggering of palliative care referrals based on such criteria could help to diminish stigma and increase the acceptance of palliative care by both patients and providers. Risk‐stratifying patients according to symptoms may lead to a more equitable distribution of specialized palliative care resources to those with the greatest need and with the greatest potential for benefit. Routine symptom screening is increasingly being implemented at cancer centers and may provide a means of identifying patients who would benefit from specialized palliative care. However, universal implementation of early specialized palliative care is not feasible, given the shortage of specialized palliative care clinicians.Ī more realistic model may be one in which basic palliative care needs are provided by oncologists, while complex problems are addressed by palliative care specialists. Randomized controlled trials have demonstrated that integration of specialized palliative care within oncology early in the course of disease improves quality of life and symptom burden.
Patients with advanced cancer suffer from multiple physical and psychosocial symptoms.
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