Early Incorporation of Patient and Family to Attention and Care Program in Oncology Versus Standard of Care

NCT ID: NCT01631565

Last Updated: 2016-11-25

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE3

Total Enrollment

201 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-05-31

Study Completion Date

2016-01-31

Brief Summary

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There is recent evidence that early palliative care administered to patients helps for their quality of life (QoL). It is however not part of the standard multidisciplinary treatment.

This study intents to evaluate the effect of early palliative care in patients with advanced Non-Small Cell Lung Cancer (NSCLC) compared to the standard of care.

Detailed Description

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The multidisciplinary approach of palliative care for symptom management has an impact on the quality of life (QoL) of patients and their families. The World Health Organization (WHO) and the American Society of Clinical Oncology (ASCO) recommend incorporating early palliative care, simultaneously with cancer treatment. Unfortunately, this recommendation has not been followed in many cancer centers and late referrals to hospice are still frequent.

Patients with lung cancer have more symptoms than patients with other cancer. The impact on QoL and symptom management has acquired a great relevance. However, few studies demonstrating the benefit of early incorporation of palliative care in the management of patients with advanced lung cancer have been shown.

Palliative care is defined as the care given to patients with progressive active and advanced disease, and its main purpose is the relief and prevention of suffering and improving QoL.

In Mexico, the law defines palliative care as comprehensive care for those illnesses not responsive to curative treatment and include, but are not limited, to pain and other symptoms associated with the disease and psychological care, social and spiritual, of the patients and their families.

Psychological aspects The psychological manifestations in patients with lung cancer are determined by several factors. Depression and anxiety are the most common psychological reactions. It has been identified that 25% of cancer patients suffer from major depression at some point during the course of the disease and has been associated with decreased survival and QoL. Patients with anxiety disorders become more attached to medical treatment but seek alternative treatments more often. The main objective of psychological interventions is reducing maladaptive emotional reactions. In advanced stages, caregivers also confront stress and depression that could lead to health problems.

Nutritional aspects Malnutrition is reported in 60 to 79% in patients with lung cancer and is the largest contribution to morbidity and mortality. Cachexia is responsible directly or indirectly to death in one third of patients. The objectives of nutritional support are: improving tolerance to specific cancer treatment, decreasing the incidence of complications and, improving the QoL. Thus, it is necessary to conduct an early diagnosis of nutritional status in order to design nutritional intervention and improve their sense of comfort and QoL.

Conditions

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Lung Neoplasms

Keywords

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Palliative Care Survival Quality of life

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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Standard care

Usual care given to the patients. Treatment, follow-up.

Group Type NO_INTERVENTION

No interventions assigned to this group

Early Palliative Care

Intervention: Early allocation to palliative care. Intervention: Nutritional counseling. Intervention: patient and care-taker psychoeducation, depression and anxiety evaluation.

Standard of care: Oncological treatment according to stage of disease (IIIb/IV).

Treatment: Chemotherapy (platins, taxans, TKIs) Baseline: BMI, and anthropometric characteristics (weight, height). Follow-up: During 6 chemotherapy circles with: Quality of Life (EORTC qlq-c30), HADS, ESAS and ZARIT.

Group Type EXPERIMENTAL

Early allocation to palliative care

Intervention Type BEHAVIORAL

Symptoms management (e.g. Pain, nausea, dehydration management).

Nutritional counseling

Intervention Type BEHAVIORAL

Nutritional status evaluation and dietary supplementation according to the patient requirements.

Psychoeducation.

Intervention Type BEHAVIORAL

Patient and care-taker psychoeducation, depression and anxiety evaluation.

Interventions

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Early allocation to palliative care

Symptoms management (e.g. Pain, nausea, dehydration management).

Intervention Type BEHAVIORAL

Nutritional counseling

Nutritional status evaluation and dietary supplementation according to the patient requirements.

Intervention Type BEHAVIORAL

Psychoeducation.

Patient and care-taker psychoeducation, depression and anxiety evaluation.

Intervention Type BEHAVIORAL

Other Intervention Names

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experimental

Eligibility Criteria

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Inclusion Criteria

* Clinical stage IV
* ECOG 0-2
* Patients treated virgin
* Receive platinum-based chemotherapy

Exclusion Criteria

* Suicide Risk
* Delirium
* Cognitive impairment
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Instituto Nacional de Cancerologia de Mexico

OTHER

Sponsor Role lead

Responsible Party

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Oscar Gerardo Arrieta Rodríguez MD

SNI II

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Oscar G Arrieta, MD Msc

Role: PRINCIPAL_INVESTIGATOR

Mexico. Nacional Cancer Institute

Locations

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National Cancer Institute- México

Mexico City, Mexico City, Mexico

Site Status

Countries

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Mexico

References

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Gore JM, Brophy CJ, Greenstone MA. How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer. Thorax. 2000 Dec;55(12):1000-6. doi: 10.1136/thorax.55.12.1000.

Reference Type BACKGROUND
PMID: 11083884 (View on PubMed)

Nieder C, Norum J. Early palliative care in patients with metastatic non-small cell lung cancer. Ann Palliat Med. 2012 Apr;1(1):84-6. doi: 10.3978/j.issn.2224-5820.2012.03.05. No abstract available.

Reference Type BACKGROUND
PMID: 25841435 (View on PubMed)

Follwell M, Burman D, Le LW, Wakimoto K, Seccareccia D, Bryson J, Rodin G, Zimmermann C. Phase II study of an outpatient palliative care intervention in patients with metastatic cancer. J Clin Oncol. 2009 Jan 10;27(2):206-13. doi: 10.1200/JCO.2008.17.7568. Epub 2008 Dec 8.

Reference Type BACKGROUND
PMID: 19064979 (View on PubMed)

Jordhoy MS, Fayers P, Loge JH, Ahlner-Elmqvist M, Kaasa S. Quality of life in palliative cancer care: results from a cluster randomized trial. J Clin Oncol. 2001 Sep 15;19(18):3884-94. doi: 10.1200/JCO.2001.19.18.3884.

Reference Type BACKGROUND
PMID: 11559726 (View on PubMed)

Ferris FD, Bruera E, Cherny N, Cummings C, Currow D, Dudgeon D, Janjan N, Strasser F, von Gunten CF, Von Roenn JH. Palliative cancer care a decade later: accomplishments, the need, next steps -- from the American Society of Clinical Oncology. J Clin Oncol. 2009 Jun 20;27(18):3052-8. doi: 10.1200/JCO.2008.20.1558. Epub 2009 May 18.

Reference Type BACKGROUND
PMID: 19451437 (View on PubMed)

Akechi T, Okuyama T, Akizuki N, Azuma H, Sagawa R, Furukawa TA, Uchitomi Y. Course of psychological distress and its predictors in advanced non-small cell lung cancer patients. Psychooncology. 2006 Jun;15(6):463-73. doi: 10.1002/pon.975.

Reference Type BACKGROUND
PMID: 16173112 (View on PubMed)

Allende S, Turcott JG, Verastegui E, Rodriguez-Mayoral O, Flores-Estrada D, Perez Camargo DA, Ramos-Ramirez M, Martinez-Hernandez JN, Onate-Ocana LF, Pina PS, Cardona AF, Arrieta O. Early Incorporation to Palliative Care (EPC) in Patients With Advanced Non-Small Cell Lung Cancer: The PACO Randomized Clinical Trial. Oncologist. 2024 Oct 3;29(10):e1373-e1385. doi: 10.1093/oncolo/oyae050.

Reference Type DERIVED
PMID: 38558247 (View on PubMed)

Other Identifiers

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PACO2012

Identifier Type: -

Identifier Source: org_study_id