‘Proactive approach’ to symptom management benefits patients with advanced cancer
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CHICAGO — Higher-intensity palliative care with more frequent symptom monitoring improved symptoms and quality of life for people with advanced cancer receiving phase 1 therapies, according to study results presented at ASCO Annual Meeting.
Palliative care alone conferred some benefit with regard to symptom reduction but did not appear associated with quality-of-life improvement, findings showed.
“We found that a proactive approach to symptom management can further improve care,” David Hui, MD, MSc, professor and director of supportive and palliative care research at The University of Texas MD Anderson Cancer Center, told Healio. “We are very encouraged by this. Further research is needed to confirm these findings, and that may allow us to further tailor a palliative care intervention for patients.”
Background and methods
Outpatient palliative care, particularly when introduced early, can improve quality of life and mood for people with cancer, Hui said. In addition, specialist palliative care is recommended for patients on phase 1 trials.
“The optimal dose of outpatient palliative care is still a subject of discussion,” Hui said. “In the outpatient setting, patients are typically seen every 4 to 6 weeks. Between those visits, patients may have symptom concerns or other questions that need to be addressed."
Hui and colleagues conducted a pilot randomized controlled trial to evaluate whether the addition of weekly remote monitoring visits to standard outpatient palliative care improved quality of life or reduced symptom burden for people undergoing cancer treatment in phase 1 trials.
The intervention included telephone calls from a nurse, as well as remote symptom assessment.
The single-center parallel group trial included 101 adults with advanced solid tumors enrolled prior to beginning phase 1 therapies. All participants had at least one Edmonton Symptom Assessment Scale (ESAS) symptom score of 4 or higher on a 10-point scale, as well as an ESAS Global Distress Score of 20 or higher on a 90-point scale.
Researchers randomly assigned 44 trial participants to palliative care alone, which included in-person or virtual outpatient visits every 4 weeks with a palliative care physician and nurse, and a psychotherapist as needed.
The other 57 participants received palliative care with technology enhancement, which included weekly symptom monitoring with ESAS electronically and a weekly nursing phone call. The clinical team was alerted if the intervention detected significant symptom distress.
Baseline characteristics in each group appeared comparable, though those assigned to specialist palliative care alone appeared to have a higher symptom burden at baseline, Hui said.
Change in ESAS global distress score served as the primary outcome measure. Change in quality of life, measured by the Functional Assessment of Chronic Illness Therapy — Spiritual Well-Being Scale (FACIT-SP), served as a secondary endpoint.
Results
By week 2, results showed significant within-group improvement in global distress score among patients assigned palliative care with technology enhancement (mean change, – 5; 95% CI, – 8.9 to – 1.2) but not among those assigned palliative care alone (mean change, – 2; 95% CI, – 5.8 to 1.8).
Those assigned palliative care with technology assessment also exhibited significant improvement in global distress scores at week 8 (mean change, – 8.1; 95% CI, – 14 to – 2.1) and week 12 (mean change, – 10.2; 95% CI, – 17.5 to – 2.9).
Analyses of trial participants who received palliative care alone showed within-group improvement in global distress scores at 4 weeks (mean change,– 5.7; 95% CI, – 11.2 to 0.2) and 12 weeks (mean change, – 8.6; 95% CI, – 15.3 to – 1.8); however, researchers observed no significant differences in quality of life over the study period.
The study lacked sufficient power to allow for between-group comparisons.
However, analysis showed significantly higher FACIT-SP scores at week 12 in the group that received palliative care with technology enhancement (mean difference, 13.9; 95% CI, 2.6-25.1).
This study provides preliminary data to support a proactive approach beyond specialist palliative care alone, Hui said. Additional studies are needed to confirm the quality-of-life benefit with the addition of technology enhancement to palliative care, he added.
“We only enrolled patients who had at least moderate symptom burden, so that may allow us to specifically target patients who have the greatest needs,” Hui told Healio. “As we move forward in precision oncology, having the right intervention for the right patient at the right time is key. This study adds to our knowledge, and hopefully we’ll be able to do more research to support this effort.”
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Hui D, et al. Abstract 12017. Presented at: ASCO Annual Meeting; May 31-June 4, 2024.
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