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Early Palliative Care in Advanced Lung and Gastrointestinal Malignancies

Randomized Study of Early Palliative Care Integrated With Standard Oncology Care Versus Standard Oncology Care Alone in Patients With Advanced Lung and Non-colorectal Gastrointestinal Malignancies

Status
Completed
Phases
NA
Study type
Interventional
Source
ClinicalTrials.gov
Registry ID
NCT01401907
Enrollment
351
Registered
2011-07-25
Start date
2011-05-31
Completion date
2019-12-31
Last updated
2023-10-19

For informational purposes only — not medical advice. Sourced from public registries and may not reflect the latest updates. Terms

Conditions

Esophageal Cancer, Gastric Cancer, Liver Cancer, Mesothelioma, Non-small Cell Lung Cancer, Pancreatic Cancer, Small Cell Lung Cancer

Keywords

Palliative care, Lung, Gastric, Liver, Pancreatic, Esophageal, Caregiver

Brief summary

The purpose of this study is to compare two types of care - standard oncology care and standard oncology care with early palliative care (started soon after diagnosis) to see which is better for improving the experience of patients and families with advanced lung and non-colorectal GI cancer. The study will use questionnaires to measure patients' and caregivers' quality of life, mood, coping and understanding of their illness.

Detailed description

Subjects and their caregiver will complete a baseline questionnaire and then be randomized to a study group. Subjects who are randomized to Standard Oncology Care will follow up with their treating oncologist. They will consult with the palliative care team at their request or at the request of the treating oncologist. They will complete questionnaires at 12 weeks and 24 weeks after enrollment. Subjects who are randomized to the Standard Oncology Care with Early Palliative Care will meet with a palliative care clinician at their next medical oncology visit or infusion visit. They will meet with the palliative care clinician at least every three weeks. They will complete questionnaires at 12 and 24 weeks after enrollment.

Interventions

patient assigned to the intervention will receive early palliative care along with standard oncology care.

Sponsors

Massachusetts General Hospital
Lead SponsorOTHER

Study design

Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
SINGLE (Outcomes Assessor)

Intervention model description

early palliative care

Eligibility

Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No

Inclusion criteria

* Confirmed metastatic lung cancer (NSCLC, small cell lung cancer, and mesothelioma)or non-colorectal GI cancer (esophageal, gastric and hepatobiliary) not being treated with curative intent * Informed of metastatic disease within the previous 8 weeks * No prior therapy for metastatic disease * Able to read questions in English or willing to complete questionnaires with the assistance of an interpreter * Relative or friend of patient who will likely accompany the patient to clinic visits

Exclusion criteria

* Significant psychiatric or other co-morbid disease

Design outcomes

Primary

MeasureTime frameDescription
Functional Assessment of Cancer Therapy (Quality of Life Measure)12 weeksThe Functional Assessment of Cancer Therapy - General is a quality of life measure with higher scores indicating better quality of life (range 0-108). We are examining the adjusted mean difference from baseline to 12 weeks in this study

Secondary

MeasureTime frameDescription
Rate of Clinically Significant Depression Symptoms Based on Hospital Anxiety and Depression ScaleWeek-12 and Week-24The hospital anxiety and depression scale examines symptoms of depression and anxiety. We compared rates of clinically significant depression symptoms (using a cut off of 8 on the depression subscale score) between study arms at week-12 and week-24.
Number and Percentage of Participants Who Reported Goal of Their Cancer Treatment is to Cure Their CancerWeek12 and Week 24We used the response to an item on Perception of Treatment and Prognosis Questionnaire to compare rates of accurate prognostic understanding between study arms. Participants reported their primary goal of their current cancer treatment: 1) to cure my cancer; 2) to lesson my suffering as much as possible; 3) for me and/or my family to be able to keep hoping; 4) to make sure I have done everything; 5) to extend my life as long as possible; 6) to help cancer research. Participants' responses were dichotomized as 1) to cure my cancer vs. all other.
Family Caregiver Quality of Life as Measured by the SF-36Week-12 and Week-24The Medical Health Outcomes Survey- Short Form (SF-36) is a measure of QOL. The SF-36 measures eight domains of health-related quality of life: physical functioning, role limitation due to physical health, bodily pain, general health perceptions, vitality, social functioning, role limitation due to emotional health, and mental health. The response choices are scored and summed to yield two physical (PCS) and mental (MCS) component summary measures with ranges from 0-100. Higher scores indicate better quality of life. We compared family caregiver PCS and MCS scores between the two study arms at week-12 and week-24 adjusting for baseline scores.
Functional Assessment of Cancer Therapy (Quality of Life Measure)24 weeksThe Functional Assessment of Cancer Therapy - General is a quality of life measure with higher scores indicating better quality of life (range 0-108). We are examining the adjusted mean difference from baseline to 24 weeks.
Number and Percentage of Family Caregivers Who Reported the Goal of Treatment is to Cure Cancer12 and 24 weeksWe used the response to an item on Perception of Treatment and Prognosis Questionnaire to compare rates of accurate prognostic understanding between study arms. Family caregivers reported their primary goal of the current cancer treatment: 1) to cure my cancer; 2) to lesson my suffering as much as possible; 3) for me and/or my family to be able to keep hoping; 4) to make sure I have done everything; 5) to extend my life as long as possible; 6) to help cancer research. Family caregivers' responses were dichotomized as 1) to cure my cancer vs. all other.
Coping (Brief Cope)Up to week-24compare mean change in approach oriented coping from baseline to week-24. Approach oriented coping scale is composed of active coping, positive reframing, and acceptance subscales. Scores range from 0-8 with higher scores indicate higher approach-oriented coping
Family Caregiver Psychological Distress (Based on the Hospital Anxiety and Depression Scale)Week 12 and Week 24We used the Hospital Anxiety and Depression scale to measure overall psychological distress in family caregivers. The Hospital Anxiety and Depression Scale contains two subscales measuring depression and anxiety respectively. When examined continuously, this scale reflects degree of psychological distress with higher scores indicating more psychological distress (range 0-42). We compared overall psychological distress (HADS-total) among family caregivers between the two study arms

Countries

United States

Participant flow

Participants by arm

ArmCount
Early Palliative Care
Subjects receive standard of care with early palliative care. early palliative care: patient assigned to the intervention will receive early palliative care along with standard oncology care.
175
Standard of Care
Subjects receives standard of care
175
Total350

Baseline characteristics

CharacteristicStandard of CareTotalEarly Palliative Care
Age, Continuous64.03 years
STANDARD_DEVIATION 10.46
64.85 years
STANDARD_DEVIATION 10.88
65.64 years
STANDARD_DEVIATION 11.26
Ethnicity (NIH/OMB)
Hispanic or Latino
2 Participants9 Participants7 Participants
Ethnicity (NIH/OMB)
Not Hispanic or Latino
173 Participants341 Participants168 Participants
Ethnicity (NIH/OMB)
Unknown or Not Reported
0 Participants0 Participants0 Participants
Race (NIH/OMB)
American Indian or Alaska Native
0 Participants4 Participants4 Participants
Race (NIH/OMB)
Asian
3 Participants8 Participants5 Participants
Race (NIH/OMB)
Black or African American
4 Participants10 Participants6 Participants
Race (NIH/OMB)
More than one race
0 Participants2 Participants2 Participants
Race (NIH/OMB)
Native Hawaiian or Other Pacific Islander
0 Participants0 Participants0 Participants
Race (NIH/OMB)
Unknown or Not Reported
1 Participants3 Participants2 Participants
Race (NIH/OMB)
White
167 Participants323 Participants156 Participants
Sex: Female, Male
Female
77 Participants161 Participants84 Participants
Sex: Female, Male
Male
98 Participants189 Participants91 Participants

Adverse events

Event typeEG000
affected / at risk
EG001
affected / at risk
deaths
Total, all-cause mortality
27 / 17532 / 175
other
Total, other adverse events
0 / 1750 / 175
serious
Total, serious adverse events
0 / 1750 / 175

Outcome results

Primary

Functional Assessment of Cancer Therapy (Quality of Life Measure)

The Functional Assessment of Cancer Therapy - General is a quality of life measure with higher scores indicating better quality of life (range 0-108). We are examining the adjusted mean difference from baseline to 12 weeks in this study

Time frame: 12 weeks

ArmMeasureValue (MEAN)
Early Palliative CareFunctional Assessment of Cancer Therapy (Quality of Life Measure)81.10 units on a scale
Standard of CareFunctional Assessment of Cancer Therapy (Quality of Life Measure)77.70 units on a scale
Secondary

Coping (Brief Cope)

compare mean change in approach oriented coping from baseline to week-24. Approach oriented coping scale is composed of active coping, positive reframing, and acceptance subscales. Scores range from 0-8 with higher scores indicate higher approach-oriented coping

Time frame: Up to week-24

ArmMeasureValue (MEAN)
Early Palliative CareCoping (Brief Cope)0.21 units on a scale
Standard of CareCoping (Brief Cope)-0.88 units on a scale
Secondary

Family Caregiver Psychological Distress (Based on the Hospital Anxiety and Depression Scale)

We used the Hospital Anxiety and Depression scale to measure overall psychological distress in family caregivers. The Hospital Anxiety and Depression Scale contains two subscales measuring depression and anxiety respectively. When examined continuously, this scale reflects degree of psychological distress with higher scores indicating more psychological distress (range 0-42). We compared overall psychological distress (HADS-total) among family caregivers between the two study arms

Time frame: Week 12 and Week 24

Population: Looking at the HADS-total score at week-12 and week-24. Please note the number of participants included in week-12 and week-24 analyses reflect the participants who completed the hospital anxiety and depression scale at these time points (study completers), which explains the discrepancy with the flow chart.

ArmMeasureGroupValue (MEAN)
Early Palliative CareFamily Caregiver Psychological Distress (Based on the Hospital Anxiety and Depression Scale)HADS-Total Week-129.02 units on a scale
Early Palliative CareFamily Caregiver Psychological Distress (Based on the Hospital Anxiety and Depression Scale)HADS-Total Week-249.82 units on a scale
Standard of CareFamily Caregiver Psychological Distress (Based on the Hospital Anxiety and Depression Scale)HADS-Total Week-1210.48 units on a scale
Standard of CareFamily Caregiver Psychological Distress (Based on the Hospital Anxiety and Depression Scale)HADS-Total Week-2410.72 units on a scale
Secondary

Family Caregiver Quality of Life as Measured by the SF-36

The Medical Health Outcomes Survey- Short Form (SF-36) is a measure of QOL. The SF-36 measures eight domains of health-related quality of life: physical functioning, role limitation due to physical health, bodily pain, general health perceptions, vitality, social functioning, role limitation due to emotional health, and mental health. The response choices are scored and summed to yield two physical (PCS) and mental (MCS) component summary measures with ranges from 0-100. Higher scores indicate better quality of life. We compared family caregiver PCS and MCS scores between the two study arms at week-12 and week-24 adjusting for baseline scores.

Time frame: Week-12 and Week-24

Population: Adjusted Means controlling for baseline scores. The different rows reflect Week-12 and Week-24 outcomes on SF-36 PCS and MCS domains. The number of participants included in week-12 and week-24 analyses reflect the participants who completed the SF-36 at these time points, which explains the discrepancy with the flow chart.

ArmMeasureGroupValue (MEAN)
Early Palliative CareFamily Caregiver Quality of Life as Measured by the SF-36SF36 PCS Week-1252.94 units on a scale
Early Palliative CareFamily Caregiver Quality of Life as Measured by the SF-36SF36 MCS Week-1247.00 units on a scale
Early Palliative CareFamily Caregiver Quality of Life as Measured by the SF-36SF36 PCS Week-2452.71 units on a scale
Early Palliative CareFamily Caregiver Quality of Life as Measured by the SF-36SF36 MCS Week-2446.21 units on a scale
Standard of CareFamily Caregiver Quality of Life as Measured by the SF-36SF36 MCS Week-2445.59 units on a scale
Standard of CareFamily Caregiver Quality of Life as Measured by the SF-36SF36 PCS Week-1251.40 units on a scale
Standard of CareFamily Caregiver Quality of Life as Measured by the SF-36SF36 PCS Week-2453.22 units on a scale
Standard of CareFamily Caregiver Quality of Life as Measured by the SF-36SF36 MCS Week-1245.92 units on a scale
Secondary

Functional Assessment of Cancer Therapy (Quality of Life Measure)

The Functional Assessment of Cancer Therapy - General is a quality of life measure with higher scores indicating better quality of life (range 0-108). We are examining the adjusted mean difference from baseline to 24 weeks.

Time frame: 24 weeks

Population: The analysis focuses on participants who completed week-24 questionnaires (N = 118 in the early palliative care arm, and N = 124 in the standard of care arm)

ArmMeasureValue (MEAN)
Early Palliative CareFunctional Assessment of Cancer Therapy (Quality of Life Measure)81.26 units on a scale
Standard of CareFunctional Assessment of Cancer Therapy (Quality of Life Measure)75.90 units on a scale
Secondary

Number and Percentage of Family Caregivers Who Reported the Goal of Treatment is to Cure Cancer

We used the response to an item on Perception of Treatment and Prognosis Questionnaire to compare rates of accurate prognostic understanding between study arms. Family caregivers reported their primary goal of the current cancer treatment: 1) to cure my cancer; 2) to lesson my suffering as much as possible; 3) for me and/or my family to be able to keep hoping; 4) to make sure I have done everything; 5) to extend my life as long as possible; 6) to help cancer research. Family caregivers' responses were dichotomized as 1) to cure my cancer vs. all other.

Time frame: 12 and 24 weeks

Population: Proportion of caregiver goal is cure at week-12 and week-24. Please note the number of participants reflect those who completed the Perception of Treatment and Prognosis Questionnaire at week-12 and week-24, which explains the discrepancy with the participants flow.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Early Palliative CareNumber and Percentage of Family Caregivers Who Reported the Goal of Treatment is to Cure CancerGoal Cure Week-1234 Participants
Early Palliative CareNumber and Percentage of Family Caregivers Who Reported the Goal of Treatment is to Cure CancerGoal Cure Week-2419 Participants
Standard of CareNumber and Percentage of Family Caregivers Who Reported the Goal of Treatment is to Cure CancerGoal Cure Week-1240 Participants
Standard of CareNumber and Percentage of Family Caregivers Who Reported the Goal of Treatment is to Cure CancerGoal Cure Week-2429 Participants
Secondary

Number and Percentage of Participants Who Reported Goal of Their Cancer Treatment is to Cure Their Cancer

We used the response to an item on Perception of Treatment and Prognosis Questionnaire to compare rates of accurate prognostic understanding between study arms. Participants reported their primary goal of their current cancer treatment: 1) to cure my cancer; 2) to lesson my suffering as much as possible; 3) for me and/or my family to be able to keep hoping; 4) to make sure I have done everything; 5) to extend my life as long as possible; 6) to help cancer research. Participants' responses were dichotomized as 1) to cure my cancer vs. all other.

Time frame: Week12 and Week 24

Population: The different rows reflect analyses at week-12 and week-24. Please note the number of participants included in week-12 and week-24 analyses reflect the participants who completed the Perception of Treatment and Prognosis Questionnaire at these time points (study completers), which explains the discrepancy with the flow chart.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Early Palliative CareNumber and Percentage of Participants Who Reported Goal of Their Cancer Treatment is to Cure Their CancerGoal Cure Week-1241 Participants
Early Palliative CareNumber and Percentage of Participants Who Reported Goal of Their Cancer Treatment is to Cure Their CancerGoal Cure Week-2437 Participants
Standard of CareNumber and Percentage of Participants Who Reported Goal of Their Cancer Treatment is to Cure Their CancerGoal Cure Week-1250 Participants
Standard of CareNumber and Percentage of Participants Who Reported Goal of Their Cancer Treatment is to Cure Their CancerGoal Cure Week-2432 Participants
Secondary

Rate of Clinically Significant Depression Symptoms Based on Hospital Anxiety and Depression Scale

The hospital anxiety and depression scale examines symptoms of depression and anxiety. We compared rates of clinically significant depression symptoms (using a cut off of 8 on the depression subscale score) between study arms at week-12 and week-24.

Time frame: Week-12 and Week-24

Population: The two rows examine outcomes at two different time points week-12 and week-24. Please note the number of participants included in week-12 and week-24 analyses reflect the participants who completed the hospital anxiety and depression scale at these time points (study completers), which explains the discrepancy with the flow chart.

ArmMeasureGroupValue (COUNT_OF_PARTICIPANTS)
Early Palliative CareRate of Clinically Significant Depression Symptoms Based on Hospital Anxiety and Depression ScaleWeek-1229 Participants
Early Palliative CareRate of Clinically Significant Depression Symptoms Based on Hospital Anxiety and Depression ScaleWeek-2424 Participants
Standard of CareRate of Clinically Significant Depression Symptoms Based on Hospital Anxiety and Depression ScaleWeek-1232 Participants
Standard of CareRate of Clinically Significant Depression Symptoms Based on Hospital Anxiety and Depression ScaleWeek-2432 Participants

Source: ClinicalTrials.gov · Data processed: Mar 4, 2026