Esophageal Cancer, Gastric Cancer, Liver Cancer, Mesothelioma, Non-small Cell Lung Cancer, Pancreatic Cancer, Small Cell Lung Cancer
Conditions
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
Study design
Intervention model description
early palliative care
Eligibility
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
| Measure | Time frame | Description |
|---|---|---|
| Functional Assessment of Cancer Therapy (Quality of Life Measure) | 12 weeks | 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 |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Rate of Clinically Significant Depression Symptoms Based on Hospital Anxiety and Depression Scale | Week-12 and Week-24 | 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. |
| Number and Percentage of Participants Who Reported Goal of Their Cancer Treatment is to Cure Their Cancer | Week12 and Week 24 | 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. |
| Family Caregiver Quality of Life as Measured by the SF-36 | Week-12 and Week-24 | 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. |
| Functional Assessment of Cancer Therapy (Quality of Life Measure) | 24 weeks | 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. |
| Number and Percentage of Family Caregivers Who Reported the Goal of Treatment is to Cure Cancer | 12 and 24 weeks | 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. |
| Coping (Brief Cope) | Up to week-24 | 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 |
| Family Caregiver Psychological Distress (Based on the Hospital Anxiety and Depression Scale) | Week 12 and Week 24 | 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 |
Countries
United States
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| 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 |
| Total | 350 |
Baseline characteristics
| Characteristic | Standard of Care | Total | Early Palliative Care |
|---|---|---|---|
| Age, Continuous | 64.03 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 Participants | 9 Participants | 7 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 173 Participants | 341 Participants | 168 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) American Indian or Alaska Native | 0 Participants | 4 Participants | 4 Participants |
| Race (NIH/OMB) Asian | 3 Participants | 8 Participants | 5 Participants |
| Race (NIH/OMB) Black or African American | 4 Participants | 10 Participants | 6 Participants |
| Race (NIH/OMB) More than one race | 0 Participants | 2 Participants | 2 Participants |
| Race (NIH/OMB) Native Hawaiian or Other Pacific Islander | 0 Participants | 0 Participants | 0 Participants |
| Race (NIH/OMB) Unknown or Not Reported | 1 Participants | 3 Participants | 2 Participants |
| Race (NIH/OMB) White | 167 Participants | 323 Participants | 156 Participants |
| Sex: Female, Male Female | 77 Participants | 161 Participants | 84 Participants |
| Sex: Female, Male Male | 98 Participants | 189 Participants | 91 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 27 / 175 | 32 / 175 |
| other Total, other adverse events | 0 / 175 | 0 / 175 |
| serious Total, serious adverse events | 0 / 175 | 0 / 175 |
Outcome results
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
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Early Palliative Care | Functional Assessment of Cancer Therapy (Quality of Life Measure) | 81.10 units on a scale |
| Standard of Care | Functional Assessment of Cancer Therapy (Quality of Life Measure) | 77.70 units on a scale |
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
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Early Palliative Care | Coping (Brief Cope) | 0.21 units on a scale |
| Standard of Care | Coping (Brief Cope) | -0.88 units on a scale |
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.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Early Palliative Care | Family Caregiver Psychological Distress (Based on the Hospital Anxiety and Depression Scale) | HADS-Total Week-12 | 9.02 units on a scale |
| Early Palliative Care | Family Caregiver Psychological Distress (Based on the Hospital Anxiety and Depression Scale) | HADS-Total Week-24 | 9.82 units on a scale |
| Standard of Care | Family Caregiver Psychological Distress (Based on the Hospital Anxiety and Depression Scale) | HADS-Total Week-12 | 10.48 units on a scale |
| Standard of Care | Family Caregiver Psychological Distress (Based on the Hospital Anxiety and Depression Scale) | HADS-Total Week-24 | 10.72 units on a scale |
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.
| Arm | Measure | Group | Value (MEAN) |
|---|---|---|---|
| Early Palliative Care | Family Caregiver Quality of Life as Measured by the SF-36 | SF36 PCS Week-12 | 52.94 units on a scale |
| Early Palliative Care | Family Caregiver Quality of Life as Measured by the SF-36 | SF36 MCS Week-12 | 47.00 units on a scale |
| Early Palliative Care | Family Caregiver Quality of Life as Measured by the SF-36 | SF36 PCS Week-24 | 52.71 units on a scale |
| Early Palliative Care | Family Caregiver Quality of Life as Measured by the SF-36 | SF36 MCS Week-24 | 46.21 units on a scale |
| Standard of Care | Family Caregiver Quality of Life as Measured by the SF-36 | SF36 MCS Week-24 | 45.59 units on a scale |
| Standard of Care | Family Caregiver Quality of Life as Measured by the SF-36 | SF36 PCS Week-12 | 51.40 units on a scale |
| Standard of Care | Family Caregiver Quality of Life as Measured by the SF-36 | SF36 PCS Week-24 | 53.22 units on a scale |
| Standard of Care | Family Caregiver Quality of Life as Measured by the SF-36 | SF36 MCS Week-12 | 45.92 units on a scale |
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)
| Arm | Measure | Value (MEAN) |
|---|---|---|
| Early Palliative Care | Functional Assessment of Cancer Therapy (Quality of Life Measure) | 81.26 units on a scale |
| Standard of Care | Functional Assessment of Cancer Therapy (Quality of Life Measure) | 75.90 units on a scale |
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.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Early Palliative Care | Number and Percentage of Family Caregivers Who Reported the Goal of Treatment is to Cure Cancer | Goal Cure Week-12 | 34 Participants |
| Early Palliative Care | Number and Percentage of Family Caregivers Who Reported the Goal of Treatment is to Cure Cancer | Goal Cure Week-24 | 19 Participants |
| Standard of Care | Number and Percentage of Family Caregivers Who Reported the Goal of Treatment is to Cure Cancer | Goal Cure Week-12 | 40 Participants |
| Standard of Care | Number and Percentage of Family Caregivers Who Reported the Goal of Treatment is to Cure Cancer | Goal Cure Week-24 | 29 Participants |
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.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Early Palliative Care | Number and Percentage of Participants Who Reported Goal of Their Cancer Treatment is to Cure Their Cancer | Goal Cure Week-12 | 41 Participants |
| Early Palliative Care | Number and Percentage of Participants Who Reported Goal of Their Cancer Treatment is to Cure Their Cancer | Goal Cure Week-24 | 37 Participants |
| Standard of Care | Number and Percentage of Participants Who Reported Goal of Their Cancer Treatment is to Cure Their Cancer | Goal Cure Week-12 | 50 Participants |
| Standard of Care | Number and Percentage of Participants Who Reported Goal of Their Cancer Treatment is to Cure Their Cancer | Goal Cure Week-24 | 32 Participants |
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.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Early Palliative Care | Rate of Clinically Significant Depression Symptoms Based on Hospital Anxiety and Depression Scale | Week-12 | 29 Participants |
| Early Palliative Care | Rate of Clinically Significant Depression Symptoms Based on Hospital Anxiety and Depression Scale | Week-24 | 24 Participants |
| Standard of Care | Rate of Clinically Significant Depression Symptoms Based on Hospital Anxiety and Depression Scale | Week-12 | 32 Participants |
| Standard of Care | Rate of Clinically Significant Depression Symptoms Based on Hospital Anxiety and Depression Scale | Week-24 | 32 Participants |