End-of-life Project ENABLE improved quality of life, mood in advanced cancer

A nurse-led palliative care intervention that focused on physical and psychosocial issues improved quality of life and mood among patients with advanced cancer, according to data from the Project ENABLE II randomized, controlled trial. The intervention did not, however, improve symptom intensity scores or reduce the number of days in the hospital or intensive care unit, or the number of emergency department visits.

“While our study did not show that early intervention for patients with advanced cancer by a nurse-led program improved symptoms or reduced use of some resources, the study did show that it provides some patients with advanced cancer a higher quality of life and mood,” researchers wrote.

Between November 2003 and May 2008, researchers randomly assigned 322 patients with advanced gastrointestinal tract, lung, genitourinary tract and breast cancers to palliative care intervention (n=161) or usual care. Advanced practice nurses executed the intervention — Project ENABLE (Educate, Nurture, Advise Before Life Ends) — a multicomponent, psychoeducational intervention. The intervention included four weekly education sessions and monthly follow-up sessions until death or study completion.

Quality of life, symptom intensity and mood were measured at baseline, one month and every three months until death or study completion.

During the course of the study, there was no statistically significant difference between the groups regarding the number of participants who received parenteral chemotherapy or radiation therapy.

Compared with usual care, intervention was associated with higher quality of life (P=.02), a trend toward lower symptom intensity (P=.06) and lower depressed mood (P=.02). Longitudinal analysis revealed similar results among patients who died during the study: higher quality of life (P=.02), no differences in symptom intensity (P=.24) and lower depressed mood (P=.03).

According to the researchers, there was no significant difference in the number of days in the hospital (P=.14), ICU (P>.99) or number of emergency department visits (P=.53). A post-hoc exploratory analysis demonstrated no significant difference in survival among the two groups.

Bakitas M. JAMA. 2009;302:741-749.