A Clustered Randomized Controlled Trial of Symptom Screening and Automatic Referral for Supportive Care for Patients with GI Cancer Care Needs

Philippa Helen Hawley, Narsis Afghari, Catherine Courteau

Abstract


Purpose

To explore the implementation of symptom screening and supportive/palliative care referral pathway in patients newly referred to a medical oncology clinic.

Methods

Eighty-eight subjects were recruited in each study arm. Intervention subjects were assessed by a member of the supportive/palliative care team if they had a severity score of >3/10. Controls received normal care, including discretionary referral. Symptom severity and quality of life were assessed over 5 months. Data on survival, care setting of death (home, hospice or hospital) and long-term resource use was collected for a further 2 years.

Results

Screening led to 141 specialist supportive/palliative care visits in the intervention arm versus 9 in controls. There were no differences in symptom severity or the long-term outcomes measured. The service was however not overwhelmed.  Considerations on timing and mode of administration of screening tools were revealed.

Conclusions

Triaging of positive screens is an important role for oncology nurses.


Full Text:

PDF

References


Antunes B, Harding R, Higginson IJ. Implementing patient-reported outcome measures in palliative care clinical practice: A systematic review of facilitators and barriers. Vol. 28, Palliative Medicine. Palliat Med; 2014. p. 158–75. Available from: https://pubmed.ncbi.nlm.nih.gov/23801463/

Azizabadi Farahani M, Assari S. Relationship Between Pain and Quality of Life. Handbook of Disease Burdens and Quality of Life Measures. Springer New York; 2010. p. 3933–53. Available from: http://dx.doi.org/10.1007/978-0-387-78665-0_229

Barbera L, Seow H, Howell D, Sutradhar R, Earle C, Liu Y, et al. Symptom burden and performance status in a population-based cohort of ambulatory cancer patients. Cancer. 2010 Dec 15;116(24):5767–76. Available from: https://pubmed.ncbi.nlm.nih.gov/21136579/

Bischoff K, Weinberg V, Rabow MW. Palliative and oncologic co-management: Symptom management for outpatients with cancer. Support Care Cancer 2013;21(11):3031–7. Available from: https://pubmed.ncbi.nlm.nih.gov/23794100/

Blackhall LJ, Read P, Stukenborg G, Dillon P, Barclay J, Romano A, et al. CARE track for advanced cancer: Impact and timing of an outpatient palliative care clinic. J Palliat Med. 2016 Jan 1;19(1):57–63. Available from: https://pubmed.ncbi.nlm.nih.gov/26624851/

Bruera E, Yennurajalingam S. Palliative care in advanced cancer patients: how and when? Oncologist 2012;17(2):267–73. Available from: https://pubmed.ncbi.nlm.nih.gov/22252934

Burt M, Kamal AH. Practical Strategies for Optimizing and Integrating Palliative Care in Cancer. Vol. 20, Current Oncology Reports. Current Medicine Group LLC 1; 2018. Available from: https://pubmed.ncbi.nlm.nih.gov/30421161/

Chang VT, Hwang SS, Feuerman M. Validation of the Edmonton Symptom Assessment Scale. Cancer 2000;88(9):2164–71. Available from: http://dx.doi.org/10.1002/(sici)1097-0142(20000501)88:9%3C2164::aid-cncr24%3E3.0.co

Courteau C, Chaput G, Musgrave L, Khadoury A. Patients with advanced cancer: when, why, and how to refer to palliative care services. Curr Oncol. 2018 Dec;25(6):403–8. Available from: https://pubmed.ncbi.nlm.nih.gov/30607115

Etkind SN, Daveson BA, Kwok W, Witt J, Bausewein C, Higginson IJ, et al. Capture, transfer, and feedback of patient-centered outcomes data in palliative care populations: Does it make a difference? A systematic review. Vol. 49, Journal of Pain and Symptom Management. Elsevier Inc.; 2015. p. 611–24. Available from: https://pubmed.ncbi.nlm.nih.gov/25135657/

Fadhlaoui A, Mrad H, Vinette B, Bilodeau K. The early integration of palliative care into oncology care: a rapid review. Canadian Oncology Nursing Journal 2022; 32(4):2368-8076. DOI: 10.5737/23688076324505

Ferrell B, Sun V, Hurria A, Cristea M, Raz DJ, Kim JY, et al. Interdisciplinary Palliative Care for Patients with Lung Cancer. J Pain Symptom Manage. 2015 Dec 1;50(6):758–67. Available from: https://pubmed.ncbi.nlm.nih.gov/26296261/

Funk R, Cisneros C, Williams RC, Kendall J, Hamann HA. What happens after distress screening? Patterns of supportive care service utilization among oncology patients identified through a systematic screening protocol. Support Care Cancer. 2016 Jul 1;24(7):2861–8. Available from: https://pubmed.ncbi.nlm.nih.gov/26838023/

Gibbins J, Bhatia R, Forbes K, Reid CM. What do patients with advanced incurable cancer want from the management of their pain? A qualitative study. Palliat Med. 2014;28(1):71–8. Available from: https://pubmed.ncbi.nlm.nih.gov/23670721/

Goel MK, Khanna P, Kishore J. Understanding survival analysis: Kaplan-Meier estimate. Int J Ayurveda Res [Internet]. 2010 Oct;1(4):274–8. Available from: https://pubmed.ncbi.nlm.nih.gov/21455458

Graham JW, Olchowski AE, Gilreath TD. How Many Imputations are Really Needed? Some Practical Clarifications of Multiple Imputation Theory. Prev Sci. 2007;8(3):206–13. Available from: http://dx.doi.org/10.1007/s11121-007-0070-9

Hawley PH. The Bow Tie Model of 21st Century Palliative Care. J Pain Symptom Manage 2014;47(1):e2–5. Available from: http://dx.doi.org/10.1016/j.jpainsymman.2013.10.009

Hemming K, Girling AJ, Sitch AJ, Marsh J, Lilford RJ. Sample size calculations for cluster randomised controlled trials with a fixed number of clusters. BMC Med Res Methodol [Internet]. 2011 Jun 30;11:102. Available from:https://pubmed.ncbi.nlm.nih.gov/21718530

Hui D, Bruera E. Models of integration of oncology and palliative care. Vol. 4, Annals of palliative medicine. Ann Palliat Med; 2015:89–98.Available from: https://pubmed.ncbi.nlm.nih.gov/26231806/

Hui D, Bruera E. The Edmonton Symptom Assessment System 25 Years Later: Past, Present, and Future Developments. J Pain Symptom Manage. 2016/12/29. 2017 Mar;53(3):630–43. Available from: https://pubmed.ncbi.nlm.nih.gov/28042071

Hui D, Kim SH, Roquemore J, Dev R, Chisholm G, Bruera E. Impact of timing and setting of palliative care referral on quality of end-of-life care in cancer patients. Cancer. 2014;120(11):1743–9. Available from:/pmc/articles/PMC4073257/?report=abstract

Hui D, Shamieh O, Paiva CE, Perez-Cruz PE, Kwon JH, Muckaden MA, et al. Minimal clinically important differences in the Edmonton Symptom Assessment Scale in cancer patients: A prospective, multicenter study. Cancer 2015 Sep 1;121(17):3027–35. Available from: https://pubmed.ncbi.nlm.nih.gov/26059846/

Hui D, Shamieh O, Paiva CE, Khamash O, Perez-Cruz PE, Kwon JH, et al. Minimal Clinically Important Difference in the Physical, Emotional, and Total Symptom Distress Scores of the Edmonton Symptom Assessment System. J Pain Symptom Manage 2016 Feb;51(2):262–9. Available from: https://pubmed.ncbi.nlm.nih.gov/26482223

Jang RW, Krzyzanowska MK, Zimmermann C, Taback N, Alibhai SM. Palliative care and the aggressiveness of end-of-life care in patients with advanced pancreatic cancer. J Natl Cancer Inst. 2015 Jan 20;107(3):dju424. doi: 10.1093/jnci/dju424. PMID: 25609233.

Kim Y, Yen IH, Rabow MW. Comparing symptom burden in patients with metastatic and nonmetastatic cancer. J Palliat Med 2016 Jan 1;19(1):64–8. Available from: https://pubmed.ncbi.nlm.nih.gov/22663083/

May P, Garrido MM, Cassel JB, Kelley AS, Meier DE, Normand C, et al. Prospective cohort study of hospital palliative care teams for inpatients with advanced cancer: Earlier consultation is associated with larger cost-saving effect. J Clin Oncol. 2015 Sep;33(25):2745–52. Available from: https://pubmed.ncbi.nlm.nih.gov/26056178/

Morita T, Fujimoto K, Namba M, Sasaki N, Ito T, Yamada C, et al. Palliative care needs of cancer outpatients receiving chemotherapy: An audit of a clinical screening project. Support Care Cancer. 2008 Jan;16(1):101–7. Available from: https://pubmed.ncbi.nlm.nih.gov/17611783/

Morita T, Sato K, Miyashita M, Akiyama M, Kato M, Kawagoe S, Kinoshita H, et al. Exploring the perceieved changes and the reasons why expected outcomes were not obtained in individual levels in a successful regional palliative care intervention trial: an analysis for interpretation. Support Care Cancer 2013 21:3393-3402

Myers WR. Handling Missing Data in Clinical Trials: An Overview. Drug Inf J. 2000;34(2):525–33. Available from: http://dx.doi.org/10.1177/009286150003400221

National Cancer Institute. NCI Dictionary of Cancer Terms - National Cancer Institute. Available from: https://www.cancer.gov/publications/dictionaries/cancer-terms/expand/A [cited Dec 21, 2022]

R-3.4.3 for Windows (32/64 bit) 2017. Available from: https://cran.r-project.org/bin/windows/base/old/3.4.3/

Rombach I, Rivero-Arias O, Gray AM, Jenkinson C, Burke Ó. The current practice of handling and reporting missing outcome data in eight widely used PROMs in RCT publications: a review of the current literature. Qual Life Res 2016 Jul;25(7):1613–23. Available from: https://pubmed.ncbi.nlm.nih.gov/26821918

Schenker Y, Bahary N, Claxton R, Childers J, Chu E, Kavalieratos D, et al. A Pilot Trial of Early Specialty Palliative Care for Patients with Advanced Pancreatic Cancer: Challenges Encountered and Lessons Learned. J Palliat Med 2018;21(1):28–36. Available from: https://pubmed.ncbi.nlm.nih.gov/28772092/

Schenker Y, Crowley-Matoka M, Dohan D, Rabow MW, Smith CB, White DB, et al. Oncologist factors that influence referrals to subspecialty palliative care clinics. J Oncol Pract. 2014;10(2). Available from: https://pubmed.ncbi.nlm.nih.gov/24301842/

Schneider A, Hommel G, Blettner M. Linear regression analysis: part 14 of a series on evaluation of scientific publications. Dtsch Arztebl Int [Internet]. 2010/11/05. 2010 Nov;107(44):776–82. Available from: https://pubmed.ncbi.nlm.nih.gov/21116397

Slama O, Pochop L, Sedo J, Svancara J, Sedova P, Svetlakova L, et al. Effects of Early and Systematic Integration of Specialist Palliative Care in Patients with Advanced Cancer: Randomized Controlled Trial PALINT. J Palliat Med. 2020 May 8; Available from: https://pubmed.ncbi.nlm.nih.gov/32391740/

Sperandei S. Understanding logistic regression analysis. Biochem medica. 2014 Feb 15;24(1):12–8. Available from: https://pubmed.ncbi.nlm.nih.gov/24627710

Temel JS, Greer JA, El-Jawahri A, Pirl WF, Park ER, Jackson VA, et al. Effects of early integrated palliative care in patients with lung and gi cancer: A randomized clinical trial. J Clin Oncol 2017;35(8):834–41. Available from: https://pubmed.ncbi.nlm.nih.gov/28029308/

Temel JS, Sloan J, Zemla T, Greer JA, Jackson VA, El-Jawahri A, et al. Multisite, Randomized Trial of Early Integrated Palliative and Oncology Care in Patients with Advanced Lung and Gastrointestinal Cancer: Alliance A221303. J Palliat Med. 2020 Jul 1;23(7):922–9. Available from: https://pubmed.ncbi.nlm.nih.gov/32031887/

Torgerson DJ. Contamination in trials: is cluster randomisation the answer? BMJ [Internet]. 2001 Feb 10;322(7282):355–7. Available from: https://pubmed.ncbi.nlm.nih.gov/11159665

Vanbutsele G, Van Belle S, Surmont V, De Laat M, Colman R, Eecloo K, et al. Effect of early and systematic integration of palliative care in patients with advanced cancer: a randomised controlled trial. Lancet Oncol 2018;S1470-2045(18)30060-3

Walling AM, Tiznado D,Asch S, Malin J, Pantoja P, Sydney M et al. The qualiy of supportive cancer care in the Veterans Affairs Health System and targets for improvement. JAMA Intern Med 2013, 173(22):2071-9. doi: 10.1001/jamainternmed.2013.10797.

Wentlandt K, Krzyzanowska MK, Swami N, Rodin GM, Le LW, Zimmermann C. Referral practices of oncologists to specialized palliative care. J Clin Oncol. 2012 Dec 10 [cited 2020 Oct 2];30(35):4380–6. Available from: https://pubmed.ncbi.nlm.nih.gov/23109708/

Woo A, Lechner B, Fu T, Wong CS, Chiu N, Lam H, et al. Cut points for mild, moderate, and severe pain among cancer and non-cancer patients: a literature review. Ann Palliat Med [Internet]. 2015;4(4):176–83. Available from: http://apm.amegroups.com/article/view/7959/8893

World Health Organization. WHO Definition of Palliative Car]. World Health Organization. Available from: https://www.who.int/cancer/palliative/definition/en/ [cited Dec 21, 2022]

Xiao C, Polomano R, Bruner DW. Comparison between patient-reported and clinician-observed symptoms in oncology. Cancer Nurs. 2013 Nov-Dec;36(6):E1-E16. doi: 10.1097/NCC.0b013e318269040f. PMID: 23047799.19.

Yount SE, Rothrock N, Bass M, Beaumont JL, Pach D, Lad T, et al. A randomized trial of weekly symptom telemonitoring in advanced lung cancer. J Pain Symptom Manage. 2014;47(6):973–89. Available from: https://pubmed.ncbi.nlm.nih.gov/24210705/

Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, et al. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383(9930):1721–30. Available from: http://dx.doi.org/10.1016/s0140-6736(13)62416-2


Refbacks

  • There are currently no refbacks.


Bookmark and Share