In a single-center trial reported in JAMA Surgery, Shinall et al found that specialist palliative care did not improve quality of life or survival vs usual care in patients undergoing nonpalliative major abdominal surgery for cancer.
Study Details
In the trial, 235 patients scheduled for specified intra-abdominal cancer operations at Vanderbilt University Medical Center were randomly assigned between March 2018 and October 2021 to receive a specialist palliative care intervention (n = 117) or usual care (n = 118). Patients were undergoing one of the following procedures: partial or total gastrectomy, partial hepatectomy, partial or total pancreatectomy, partial or total colectomy or proctectomy, radical cystectomy, pelvic exenteration, cytoreductive surgery after neoadjuvant therapy for ovarian or endometrial cancer, or cytoreductive surgery and hyperthermic intraperitoneal chemotherapy.
The intervention consisted of preoperative consultation with palliative care specialists and postoperative inpatient and outpatient palliative care follow-up for 90 days. The primary endpoint was physical and functional quality of life at postoperative day 90, measured by the Functional Assessment of Cancer Therapy–General (FACT-G) Trial Outcome Index (TOI); the index is scored 0 through 56, with higher scores representing higher physical and functional quality of life.
Key Findings
Adjusted median scores on the FACT-G TOI measure of physical and functional quality of life at day 90 were 46.77 (95% confidence interval [CI] = 44.18–49.04) in the intervention group vs 46.23 (95% CI = 43.08–48.14) in the usual-care group (odds ratio [OR] = 1.17, 95% CI = 0.77–1.80, P = .46).
No significant difference between the intervention and usual-care groups was observed in overall quality of life measured by FACT-G score at 90 days (OR = 1.09, 95% CI = 0.75–1.58). No significant differences between the intervention and usual-care groups were observed in days alive at home through day 90 (median = 84 vs 83; OR = 0.87, 95% CI = 0.69–1.11) or 1-year overall survival (hazard ratio = 0.97, 95% CI = 0.50–1.88).
The investigators concluded, “This randomized clinical trial showed no evidence that early specialist palliative care improves the quality of life of patients undergoing nonpalliative cancer operations.”
Myrick C. Shinall Jr, MD, PhD, of the Division of General Surgery, Vanderbilt University Medical Center, is the corresponding author for the JAMA Surgery article.
Disclosure: The study was funded by grants from the National Institutes of Health. For full disclosures of the study authors, visit jamanetwork.com.
