In a study reported in JAMA Network Open, Aslakson et al found that perioperative surgeon/palliative care team co-management did not improve health-related quality of life vs surgeon team management alone in patients undergoing curative-intent surgery for upper gastrointestinal cancers.
Study Details
In the trial, 359 patients from five U.S. centers who were scheduled to undergo curative-intent surgery for upper gastrointestinal cancers were randomly assigned between October 2018 and March 2022 to receive surgeon/palliative care team management (n = 182) or surgeon team management alone (n = 177). Patients who received surgeon/palliative care co-management met with the palliative care team in person or via telephone before surgery; 1 week after surgery; and 1, 2, and 3 months after surgery. For patients who were part of surgeon team management alone, surgeons were encouraged to follow National Comprehensive Cancer Network recommendations for palliative care consultation.
The primary outcome measure was patient-reported health-related quality of life at 3 months after surgery on intention-to-treat analysis measured by the following tools: Functional Assessment of Chronic Illness Therapy–Palliative Care (FACIT-Pal) Subscale (scores range from 0–184, with higher scores indicating better quality of life); Functional Assessment of Cancer Therapy–General (FACT-G) instrument (scores range from 0–108; higher scores indicate better health-related quality of life); and the Patient-Reported Outcomes Measurement Information System (PROMIS-29) profile summary mental health and physical health scores.
Key Findings
Overall, 90% of patients in the surgeon/palliative care group and 11% in the surgeon team management–alone group received palliative care consultation. A total of 57% of patients underwent surgery for pancreatic cancer.
No significant differences at 3 months were observed between the surgeon/palliative care group and surgeon-alone group in health-related quality of life on the FACIT-Pal subscale (mean score [standard deviation, SD] = 138.54 [28.28] vs 136.90 [28.96], P = .62) or FACT-G score (mean [SD] = 79.90 [17.14] vs 79.40 [17.45], P = .80). No significant differences were observed on the PROMIS-29 physical health (mean [SD] = −0.43 [0.89] vs −0.50 [1.01], P = .56) or mental health (mean [SD] = −0.07 [0.87] vs −0.07 [0.84], P = .98) scores. No significant difference in the incidence of death between enrollment and 3 months after surgery was observed (7 patients [4.1%] vs 6 patients [3.7%], P > .99).
The investigators concluded: “To date, this is the first multisite randomized clinical trial to evaluate perioperative palliative care and the earliest integration of palliative care into cancer care. Unlike in medical oncology practice, the data from this trial do not suggest palliative care–associated improvements in patient-reported outcomes among patients pursuing curative-intent surgeries for upper gastrointestinal cancers.”
Rebecca A. Aslakson, MD, of the Department of Anesthesiology, Lerner College of Medicine at the University of Vermont, is the corresponding author of the JAMA Network Open article.
Disclosure: The study was supported by the Patient-Centered Outcomes Research Institute, National Institutes of Health, National Cancer Institute, and others. For full disclosures of the study authors, visit jamanetwork.com.
