Researchers found that implementation of a structured palliative care process is feasible, according to a pilot study of patients with recurrent ovarian cancer. These findings were presented during the Society of Gynecologic Oncology 2021 Virtual Annual Meeting.
"The model of cancer care is no longer one of cure versus comfort," noted study author Brittany Davidson, MD, Assistant Professor of Obstetrics and Gynecology at Duke University. "Since 2012, [ASCO] has recommended that combined standard oncology care and palliative care should be considered early in the course of illness for those with metastatic or advanced cancer and/or a high burden of illness.
"In 2016, they updated this recommendation, removing verbiage surrounding the burden of illness, thus recommending palliative care involvement early in the course of disease for all patients with advanced cancer," she continued. "Patients with advanced ovarian cancer may experience significant symptoms at several points in their disease trajectory. Unfortunately, many of these patients do not have specialized palliative care involvement in their treatment paradigms for a variety of reasons. And, on top of this modeling, studies demonstrate a worsening shortage of palliative care physicians over the next decade."
Methods & Findings
The study, "H.O.P.E & Healing: A randomized pilot study of structured palliative care referrals in recurrent ovarian cancer," sought to test the effect of a structured palliative care intervention on the quality of life among women with recurrent ovarian cancer.
Secondary objectives included assessments of the impact of this structured palliative care intervention on overall survival for patients, as well as the impact on caregiver quality of life, according to Davidson.
Eligible patients included those who were at least 18 years old and had platinum-resistant/refractory ovarian cancer or platinum-sensitive disease with a sentinel clinical event (bowel obstruction, liver metastases, pleural effusion, or ascites). These patients had to identify a primary caregiver who would also participate in the study.
"Patients were randomized in a one-to-one fashion to either the structured palliative care arm or usual care," Davidson explained. "In the structured palliative care arm, patients were asked to complete a validated symptom assessment tool known as QDACT.
"If they reported the same moderate-to-severe level symptom at two consecutive visits, they were automatically referred to palliative care specialists," she said. "If they did not meet this criteria, they continued monthly QDACT symptom assessments."
Patients in the usual care arm were only referred to palliative care specialists at the discretion of their oncologist or by patient request. In both arms, caregivers completed a quality-of-life assessment at baseline and 3-month intervals.
"QDACT is a patient-reported, quality measure-based needs assessment system that has been previously demonstrated to be feasible and useful in the outpatient palliative care setting," noted Davidson. This 92-question tool assesses nine clinical domains, including demographics, symptom assessment and management, advance care planning, psychosocial, independence and function, spirituality, prognosis, transitions and discharge, and physician quality reporting system.
The researchers observed no statistically significant difference in patient quality of life between the two arms, according to Davidson, who also noted that there was an overall decline in quality-of-life over time.
Overall survival was less than a year in both arms: 9.3 months for patients who received usual care arm compared to 10.1 months for those who underwent structured palliative care. This was not statistically or clinically different, Davidson reported.
When assessing caregivers, researchers found that the burden on a caregiver's schedule appears to impact caregiver quality of life the most. The study also showed that caregivers rated their self-esteem quite high, both at baseline and overtime, according to Davidson.
"In summary, our study demonstrates that the implementation of a structured palliative care approach is feasible in clinical practice for our patients with advanced or recurrent ovarian cancer," she said. "This was a challenging cohort to recruit because of their often-tenuous clinical status. Thus, we were unable to recruit sufficient cohort numbers to detect statistically significant differences among our various metrics."
Davidson emphasized the importance of recognizing the needs of the caregiver, as well as the importance of palliative care. "It cannot be stressed enough that we cannot forget the burden of ovarian cancer on our caregivers, and we need to recognize their role in the health and well-being of our patients.
"Incorporation of palliative care in parallel to active cancer treatment is a vital component of excellent cancer care for patients with advanced or recurrent ovarian cancer," Davidson concluded. "Further studies are needed to ascertain which interventions exactly may have the most benefit for this deserving population and how we can move these further upstream to diagnosis."
Catlin Nalley is a contributing writer.