Palliative care improves patient-reported outcomes in medical oncology patients, but there is little evidence of its effectiveness in surgical oncology patients. A nonblinded pragmatic randomized clinical trial was conducted to determine whether surgeon-palliative care team comanagement compared with surgeon-alone care would improve outcomes in patients who have upper gastrointestinal (GI) cancer and are pursuing curative-intent surgeries.

A total of 359 patients scheduled for curative-intent surgery for an upper GI cancer who hadn't previously received specialist palliative care were randomized to either surgeon-alone (enhanced usual care) or surgeon-palliative care comanagement (intervention). Those assigned to the intervention group met with a member of an interprofessional palliative care specialist team, either in person or by telephone, before surgery; one week after surgery; and one, two, and three months after surgery. Those assigned to the surgeon-only group could receive palliative care if requested by the surgical team. A total of 90% of patients in the intervention group and 11.3% of those in the enhanced usual care control group had a palliative care consultation.

No harms associated with the inclusion of palliative care specialists were reported by patients, family members, or clinicians. At three months after surgery, measures of health-related quality of life weren't significantly different between the intervention and control groups. Mortality was also similar in the two groups.

Palliative care provided by nonspecialists may be sufficient for some surgical patients, the authors conclude. Limited specialist palliative care resources could be reserved for patients with more advanced disease or more complex symptoms. They note, however, that the study population was mostly White, highly educated, and cared for in suburban and urban tertiary or quaternary medical centers, so the findings may not apply to other patient populations. Also, palliative care was mostly provided by telephone, which may have less impact than in-person consultation.