The Role of Early Systematic Best Palliative Care Versus on Request Palliative Care Consultation During Standard Oncologic Treatment for Patients With Advanced Gastric or Pancreatic Cancers: a Randomized, Controlled, Multicenter Trial.

Pancreatic Neoplasm Clinical Trial

Official title:

The Role of Early Systematic Best Palliative Care Versus on Request Palliative Care Consultation During Standard Oncologic Treatment for Patients With Advanced Gastric or Pancreatic Cancers: a Randomized, Controlled, Multicenter Trial.

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT01996540
• Other study ID #: IRST100.08
• Status: Completed
• Phase: N/A
• Start date: August 2012
• Est. completion date: November 2018

Study information

• Verified date: November 2018
• Source: Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

Title: The role of early systematic best palliative care versus on request palliative care consultation during standard oncologic treatment for patients with advanced gastric or pancreatic cancers: a randomized, controlled, multicenter trial.

Description of Study Treatment:

1. Interventional arm Patients will receive standard oncologic care and will be assigned to early systematic best palliative care. They will meet a member of the palliative care team within 2 weeks after enrolment. Thereafter, they shall be visited by a palliative care team member every 2 weeks until death. Patients assigned to this experimental arm will be evaluated if the total of palliative care visits between T0 (day of enrollment) and T1 (12±3 weeks) is ≥3. Palliative care visits and intervention has to be oriented by the General guidelines for palliative care: specific attention will be paid to assessing physical and psychosocial symptoms, establishing goals of care, assisting decision making regarding treatment, and coordinating care on the basis of the individual needs of the patients.

The doctor expert in palliative care, with regular visits in the experimental arm, must be a physician dedicated full time to palliative care, that can directly prescribe drugs and other interventions, and with a particular attention to physical, psychological, and spiritual needs.

Palliative care doctor must have the possibility to decide about organizational arrangements.

He has to perform the palliative care visit according to Temel indications.

2. Standard arm Patients will receive standard oncologic care and will be assigned to on request palliative care consultation. They will be not scheduled to meet with the palliative care service unless a meeting will be requested by the patients, the family, or the oncologist. After the time of evaluation (T1) patients will be followed by the palliative care services as needed.

Patient completes QoL (Quality of Life) and mood questionnaires at baseline and at 12 weeks ± 3.

Patients will receive standard antineoplastic treatment in both arms of the study according to best clinical practice in each participating centre.

Description:

Title: The role of early systematic best palliative care versus on request palliative care consultation during standard oncologic treatment for patients with advanced gastric or pancreatic cancers: a randomized, controlled, multicenter trial.

Short Title/Acronym: Early palliative care

Protocol Code: IRST 100.08

Study Design: randomized, controlled, multicenter trial

Study Duration: 2 years

Number of Subjects: 240

Description of Study Treatment:

1. Interventional arm Patients will receive standard oncologic care and will be assigned to early systematic best palliative care. They will meet a member of the palliative care team within 2 weeks after enrolment. Thereafter, they shall be visited by a palliative care team member every 2 weeks until death. Patients assigned to this experimental arm will be evaluated if the total of palliative care visits between T0 (day of enrollment) and T1 (12±3 weeks) is ≥3. Palliative care visits and intervention has to be oriented by the General guidelines for palliative care: specific attention will be paid to assessing physical and psychosocial symptoms, establishing goals of care, assisting decision making regarding treatment, and coordinating care on the basis of the individual needs of the patients.

The doctor expert in palliative care, with regular visits in the experimental arm, must be a physician dedicated full time to palliative care, that can directly prescribe drugs and other interventions, and with a particular attention to physical, psychological, and spiritual needs.

Palliative care doctor must have the possibility to decide about organizational arrangements.

He has to perform the palliative care visit according to Temel indications.

2. Standard arm Patients will receive standard oncologic care and will be assigned to on request palliative care consultation. They will be not scheduled to meet with the palliative care service unless a meeting will be requested by the patients, the family, or the oncologist. After the time of evaluation (T1) patients will be followed by the palliative care services as needed.

Patient completes QoL (Quality of Life) and mood questionnaires at baseline and at 12 weeks ± 3.

Patients will receive standard antineoplastic treatment in both arms of the study according to best clinical practice in each participating centre.

Primary Objective:

To assess the effects on quality of life and clinical symptoms of introducing early systematic palliative care versus on request palliative care consultation during standard oncological care on quality of life.

Secondary Objectives:

• To assess the impact of early palliative care on symptom burden and mood.

• To assess the impact of families satisfaction about care.

• To compare the use of health services, including anticancer therapy, medication prescriptions, referral to hospice, hospital admissions, emergency department visits, and the location of death between study arms.

• To compare overall survival.

Statistical Methodology:

Primary endpoint is the change in the score from T0 to T1 on the Trial Outcome Index (TOI), which is the sum of the scores of specific subscale FACT-Ga or FACT-Hep concerning physical symptoms, and physical and functional well being.

Secondary endpoints are the change in the percentage of patients with anxiety and/or depression form T0 to T1 on the Mood questionnaire; the impact of families satisfaction about care; the use of health services, including anticancer therapy, medication prescriptions, referral to hospice, hospital admissions, emergency department visits, and the location of death between study arms; the overall survival.

For each type of cancer (gastric or pancreatic), we estimate that with 120 patients the study would have 80% power to detect a significant between-group difference in the change in the TOI score from T0 to T1, with a medium effect size of 0.5 standard deviation. A total of 240 patients will be enrolled.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 394
• Est. completion date: November 2018
• Est. primary completion date: November 2, 2017
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

Inclusion Criteria:

1. diagnosis of inoperable locally advanced and/or metastatic gastric or pancreatic cancers within the previous eight weeks, any T, any N, M+ or T4 inoperable (neoadjuvant excluded);

2. patients eligible for chemotherapy and/or new target drugs treatments for metastatic or advanced disease;

3. ECOG PS 0-2 (Appendix A);

4. life expectancy >2 months;

5. both sex;

6. age =18 years;

7. all ethnic background;

8. subjects who are, in the opinion of the Investigator, able to understand this study and to cooperate with the study procedures;

9. written informed consent (Appendix B);

10. palliative care visit must be performed by a dedicated physician/team different from the medical oncology group.

Exclusion Criteria:

1. patients already receiving care from the palliative care service;

2. prior chemotherapy and/or new target drugs treatments for metastatic or advanced disease.

Related Conditions & MeSH terms

• Gastric Neoplasm
• Neoplasms
• Pancreatic Neoplasm
• Pancreatic Neoplasms
• Stomach Neoplasms

Intervention

Other:
• Interventional arm: Early best palliative care
Patients will receive standard oncologic care and will be assigned to early systematic best palliative care. They will meet a member of the palliative care team within 2 weeks after enrolment. Thereafter, they shall be visited by a palliative care team member every 2 weeks until death.

Locations

Country	Name	City	State
Italy	S. Donato, Arezzo	Arezzo
Italy	Centro di Riferimento Oncologico CRO	Aviano
Italy	Ospedale degli Infermi,	Biella
Italy	Ospedale Businco, Cagliari	Cagliari
Italy	Policlinico Universitario, Cagliari	Cagliari
Italy	ASL AL, Casale Monferrato	Casale Monferrato
Italy	Irst-Cesena	Cesena
Italy	Sant'Anna	Como
Italy	PO M.Santo, Cosenza	Cosenza
Italy	Istituti Ospitalieri, Cremona	Cremona
Italy	Sant'Anna, Ferrara	Ferrara
Italy	S.Giovanni Di Dio, Firenze	Firenze
Italy	S.Maria Annunziata,	Firenze
Italy	E.O. Galliera	Genova
Italy	U.O Oncologia medica	Lugo	RA
Italy	Palliative Care Clinic IRCCS IRST	Meldola	FC
Italy	Aulss 12,	Mestre
Italy	Istituto Nazionale Tumori, Milano	Milano
Italy	Ospedale Sacco, Milano	Milano
Italy	S.PAOLO	Milano
Italy	IOV	Padova
Italy	San Matteo	Pavia
Italy	Guglielmo da Saliceto	Piacenza
Italy	Arcispedale S. Maria Nuova	Reggio Emilia
Italy	Fatebenefratelli,	Roma
Italy	SS Trinità,	Sora - Frosinone
Italy	Gradinego	Torino
Italy	AOP 9, Trapani	Trapani
Italy	S. Maria Gruccia, Valdarno	Valdarno
Italy	AULSS 12, Venezia	Venezia

Sponsors (1)

Lead Sponsor	Collaborator
Istituto Scientifico Romagnolo per lo Studio e la cura dei Tumori

Country where clinical trial is conducted

Italy, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Quality of Life (QoL)	It is the change in the score from T0 (day of enrollment) to T1 (12±3 weeks) on the Trial Outcome Index (TOI) [which is the sum of the scores of specific subscale FACT-Ga or FACT-Hep Functional Assessment of Cancer Therapy-Gastric cancer (FACT-Ga) and Functional Assessment of Cancer Therapy-Hepatobiliary cancers (FACT-Hep) scales, concerning physical symptoms, physical and functional well being].	24 months
Secondary	Hospital Anxiety and Depression Scale (HADS)	Mood will be assessed with the use of Hospital Anxiety and Depression Scale (HADS), which is 14-item instrument composed of two subscales and screens for symptoms of anxiety and depression.	24 months
Secondary	Impact of families satisfaction	The impact of families satisfaction about care will be evaluated by an Italian version of FAMCARE questionnaire.	24 months
Secondary	Overall survival (OS)	It is the time from the date of randomization to the date of death due to any cause.	24 months