Original ResearchSystematic versus on-demand early palliative care: A randomised clinical trial assessing quality of care and treatment aggressiveness near the end of life

- We assessed the impact of systematic versus on-demand early palliative care (EPC) on quality of care outcomes.
- Use and timeliness of hospice care were more appropriate in the systematic EPC arm.
- Fewer systematic EPC patients underwent chemotherapy in the last 30 days of life.
- Percentage of home/hospice deaths was non-significantly higher for systematic EPC.
- Systematic EPC is advantageous for quality of care and quality of life.

AimEarly palliative care (EPC) in oncology has shown sparse evidence of a positive impact on patient outcomes, quality of care outcomes and costs.Patients and methodsData for this secondary analysis were taken from a trial of 207 outpatients with metastatic pancreatic cancer randomly assigned to receive standard cancer care plus on-demand EPC (standard arm) or standard cancer care plus systematic EPC (interventional arm). After 20 months' follow-up, 149 (80%) had died. Outcome measures were frequency, type and timing of chemotherapy administration, use of resources, place of death and overall survival.ResultsSome indices of end-of-life (EoL) aggressiveness had a favourable impact from systematic EPC. Interventional arm patients showed higher use of hospice services: a significantly longer median and mean period of hospice care (P = 0.025 for both indexes) and a significantly higher median and mean number of hospice admissions (both P < 0.010). In the experimental arm, chemotherapy was performed in the last 30 days of life in a significantly inferior rate with respect to control arm: 18.7% versus 27.8% (adjusted P = 0.036). Other non-significant differences were seen in favour of experimental arm.ConclusionsSystematic EPC showed a significant impact on some indicators of EoL treatment aggressiveness. These data, reinforced by multiple non-significant differences in most of the other items, suggest that quality of care is improved by this approach.This study is registered on ClinicalTrials.gov (NCT01996540).