A Collaborative Palliative and Leukemia Care Model for Patients With AML and MDS Receiving Non-Intensive Therapy
Randomized Trial of a Collaborative Palliative and Leukemia Care Model for Patients With AML and MDS Receiving Non-Intensive Therapy
Study Overview
Status
Status
Conditions
Conditions
Intervention / Treatment
Intervention / Treatment
Detailed Description
Frequently people undergoing treatment for AML or MDS experience physical and emotional symptoms during the course of their illness. These can be very distressing to both patients and their caregivers. Patients with AML or MDS receiving non-intensive therapy also often experience a rapid decline in their health status and have a limited prognosis. Despite their limited life-expectancy, they rarely engage in discussion with their clinicians regarding their goals and preferences for care at the end of life. The study doctors want to know if the early introduction of a team of clinicians that specialize in the lessening (palliation) of many of these distressing symptoms and have expertise in enhancing communication about prognosis and illness trajectory may improve the overall care of patients with acute leukemia.
This team of clinicians is called the palliative care team and they focus on ways to improve the participant's pain and other symptom management (nausea, fatigue, shortness of breath, anxiety, etc.) and to assist the participant and the participant's caregivers in coping with the emotional and social issues associated with their diagnosis. The team consists of physicians and advance practice nurses who have been specially trained in the care of patients facing serious illness.
The main purpose of this study is to compare two types of care - standard oncology care and standard oncology care with collaborative involvement of palliative care clinicians to see which is better for improving the experience of patients with AML and MDS undergoing treatment.
The purpose of this research study is to find out whether introducing patients undergoing treatment for AML or MDS to the palliative care team can improve their end-of-life communication, understanding of their prognosis, and their physical and psychological symptoms during the course of their illness.
Study Type
Study Type
Enrollment (Estimated)
Enrollment
Phase
Phase
- Not Applicable
Contacts and Locations
Study Contact
Study Contact
- Name: Areej El-Jawahri, MD
- Phone Number: 617-726-5765
- Email: ael-jawahri@partners.org
Study Locations
-
-
Massachusetts
-
Boston, Massachusetts, United States, 02114
- Massachusetts General Hospital
-
-
Ohio
-
Columbus, Ohio, United States, 43210
- Ohio State University
-
-
Participation Criteria
Eligibility Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
Patients with AML receiving non-intensive therapy including hypomethylating agents, single-agent chemotherapy, targeted therapy agents, or single or combination non-intensive agents offered on a clinical trial, including the following populations:
- Newly diagnosed AML
- Relapsed AML
- Primary refractory AML
- The ability to provide informed consent
- The ability to comprehend English or complete questionnaires with minimal assistance of an interpreter
Exclusion Criteria:
- Patients not receiving care at MGH
- Patients receiving intensive chemotherapy (requiring 4-6 week hospitalization)
- Patients receiving supportive care alone
- Major psychiatric illness or co-morbid conditions prohibiting compliance with study procedures
- Patients already receiving palliative care
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Supportive Care
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Number of Arms
Arms and Interventions
Participant Group / ArmParticipant Group / Arm |
Intervention / TreatmentIntervention / Treatment |
|---|---|
|
Experimental: Collaborative palliative and oncology care
|
Specialized medical care for people with serious illness.
This type of care is focused on providing relief from the symptoms and stress of a serious illness.
The goal is to improve quality of life for both the patient and the family
Standard care per the hospital guideline
|
|
Active Comparator: Standard oncology care
|
Standard care per the hospital guideline
|
What is the study measuring?
Primary Outcome Measures
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Time from documentation of end-of-life care preferences to death
Time Frame: up to 2 years
|
comparison of time from documentation of end-of-life care preferences to death in the electronic health records
|
up to 2 years
|
Secondary Outcome Measures
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Rates of documentation of end-of-life care preferences at least one week prior to death.
Time Frame: up to 2 years
|
Comparison of the rate of documentation of end-of-life care preferences at least one week prior to death in the electronic health record
|
up to 2 years
|
|
Patient-report of discussing end-of-life care preferences based on an item from the perception of treatment and prognosis questionnaire
Time Frame: up to 2 years
|
comparison of patient-report of discussion end-of-life care preferences between the study arms
|
up to 2 years
|
|
Compare Rate of hospitalization between the study arms
Time Frame: up to 30 days
|
Compare rates of hospitalizations within 30 days of death between the study arms
|
up to 30 days
|
|
Rate of hospice utilization and length-of-stay in hospice
Time Frame: up to 2 years
|
Compare rates of hospice utilization and length-of-stay in hospice at the end of life between the study arms
|
up to 2 years
|
|
compare quality of life
Time Frame: up to six months
|
Compare quality of life (FACT-Leuk) at week-12 and longitudinally between the study arms.
Score range 0-176 (higher scores indicating better quality of life)
|
up to six months
|
|
compare symptom burden
Time Frame: up to six months
|
Compare symptom burden (ESAS) at week-12 and longitudinally between the study arms.
the ESAS score range 0-100 with higher scores indicating worse symptom burden.
|
up to six months
|
|
compare mood
Time Frame: up to six months
|
Compare change in mood (HADS) at week-12, and longitudinally between the study arms.
HADS measures depression and anxiety symptoms (subscale range 0-21) higher scores indicating worse mood symptoms
|
up to six months
|
Other Outcome Measures
Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
caregiver-reported discussion of end-of-life care preferences as measured by the perception of treatment and prognosis questionnaire
Time Frame: one month
|
compare caregiver-reported discussion of end-of-life care preferences between the study arms at one month
|
one month
|
|
Rate of chemotherapy administration
Time Frame: up to 30 days prior to death
|
compare rate of chemotherapy administration within 30 days of death between the two study arms
|
up to 30 days prior to death
|
|
Rates of death in the hospital
Time Frame: up to 2 years
|
compare rates of death in the hospital between the two study arms
|
up to 2 years
|
|
Compare quality of end-of-life care between the two study arms
Time Frame: up to 2 years
|
compare quality of end-of-life care (FAMCARE) as reported by caregivers between the two study arms.
FAMCARE score range 0-100, higher scores indicate better quality of end-of-life care
|
up to 2 years
|
Collaborators and Investigators
Sponsor
Sponsor
Investigators
Investigators
- Principal Investigator: Areej El-Jawahri, MD, Massachusetts General Hospital
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Study Start
Primary Completion (Actual)
Primary Completion
Study Completion (Estimated)
Study Completion
Study Registration Dates
First Submitted
First Submitted
First Submitted That Met QC Criteria
First Submitted That Met QC Criteria
First Posted (Actual)
First Posted
Study Record Updates
Last Update Posted (Actual)
Last Update Posted
Last Update Submitted That Met QC Criteria
Last Update Submitted That Met QC Criteria
Last Verified
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
Other Study ID Numbers
- 17-327
- ECOR grant 230593 (Other Grant/Funding Number: ECOR)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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