A nurse-led palliative care intervention for patients with advanced cancer did not improve patient-reported outcomes after three months.
There is a considerable impairment of most aspects of quality of life among patients with advanced cancer. Adopting a holist approach to cancer care serves to address patient’s emotional needs, especially given that many of those with cancer experience depression or anxiety as a central symptom. Nevertheless, analysis of physician-patient consultations reveals how the time devoted to quality of life issues is limited although there is some data to suggest that a nurse-led palliative care intervention leads to improvements in patient’s quality of life.
To further strengthen the evidence base for nurse-led palliative care interventions, a team from the Palliative Research Centre, University of Pittsburgh, US, developed the Care Management by Oncology Nurses to Address Supportive Care Needs (CONNECT) intervention. While their pilot study found a high level of satisfaction with the intervention, the lack a control arm led the team decided to examine the impact of the CONNECT intervention in a randomised trial, compared with standard oncology care, in patients with advanced cancers. For the purposes of the study, patients with advanced, metastatic solid tumours were defined as those for whom the oncologist agreed with the statement “would not be surprised if the patient died next year”.
Enrolled patients were randomised to the CONNECT intervention or usual oncology care, which was defined as best practice oncology care. Patients randomised to the CONNECT arm received a monthly visit from a trained oncology nurse for a period of three months and the intervention itself was based on the chronic care model. Three primary outcome measures were used and designed to assess quality of life used and completed at baseline and after three months. The first was the Functional Assessment of Chronic illness therapy-palliative care (FACIT-Pal), where higher scores indicate better quality of life. The second assessed symptom burden with the Edmonton Symptom Assessment Scale (ESAS), for which higher scores reflect a greater symptom burden. The final measure was the Hospital Anxiety and Depression scale (HADS) where again, higher scores indicated greater levels of anxiety and depression.
A total of 672 patients with a mean age of 69.3 years (53.6% female) were enrolled and randomised to the palliative care intervention, CONNECT (336) or standard care. The two most common cancers were lung (36%) and gastrointestinal (19.5%). Among CONNECT patients, the mean number of completed visits was 2.2 and 56% of patients received 3 visits. With respect to the 3-month changes in the three outcome measures, there were no significant differences. For example, the mean FACIT-Pal scores were 130.7 and 134.1 (CONNECT vs standard care, adjusted mean difference = 1.20, p = 0.55). Similarly, there were no differences in the ESAS (adjusted mean difference = -.2.46, p = 0.11) or HADS scores.
The authors concluded that further work is required to identify effective palliative care interventions for those with advanced cancer.
Schenker Y et al. Effect of an Oncology Nurse–Led Primary Palliative Care Intervention on Patients with Advanced Cancer. The CONNECT Cluster Randomized Clinical Trial. JAMA Int Med 2021