Clinical trial of a supportive care team for patients with advanced cancer

Abstract

Context: Encouraging use of hospice and minimizing the use of cure-oriented aggressive interventions that detract from quality of life in the last month of life are specific targets for improvement in cancer care.

Objectives: To evaluate the effect of an interdisciplinary cancer support team (CST) on quality of care and quality of life in patients with advanced cancers.

Methods: A nonrandomized clinical trial was conducted, comparing outcomes before and after the integration of an interdisciplinary CST in routine care of adults with Stage III or IV lung, gastrointestinal, or gynecologic cancer. In the control arm, patients (n = 332) received usual care; after the initiation of the intervention arm, eligible patients (n = 278) received the CST intervention. The intervention consisted of individualized care coordination, symptom management, education, psychosocial and spiritual supports, and advance care planning throughout the 15-month study period. Quality of end-of-life care was measured through an "aggressiveness of care" index. Health-related quality of life (HRQOL) was measured with the Functional Assessment of Cancer Therapy-General.

Results: There were no statistically significant differences between groups on specific indicators of quality of care. Surviving subjects with higher survival expectancy (who also reported better baseline quality of life) in the intervention arm had the greatest improvement in HRQOL scores, compared with the other three groupings of survival expectancy by treatment group (high vs. low by intervention vs. control) (P = 0.044).

Conclusion: Individually tailored supportive services from an interdisciplinary team are associated with improved HRQOL in some patients. This has implications for the potential benefits that can be accrued from providing intensive support to all patients, even those who may appear to be at less risk for distress. There also are important methodological considerations in using aggressiveness of care indices as a measure of quality of care.

Trial registration: ClinicalTrials.gov NCT00684801.

Keywords: Supportive cancer care; aggressiveness of care index; palliative care in cancer.

Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.

Figures

Fig. 1

Subject flow diagram.

Fig. 2

Comparisons of aggressiveness of care indices for those who died (n=214). Note: SEER data as reported by Earle et al.(5) and VAH data as reported by Gonsalves et al. (4).

Fig. 3

FACT-G timeplot stratified for group and survival expectancy (n=499).