Efficacy of a Systematic Referral to Palliative Care of Patients Who Need for Palliative Care During an Unscheduled Visit in Comprehensive Anticancer Centers
- Conditions
- EmergenciesCancer
- Interventions
- Other: Systematic referral to a palliative care team
- Registration Number
- NCT06150027
- Lead Sponsor
- Centre Leon Berard
- Brief Summary
This is a randomized, multicenter, prospective, phase III study conducted in daily emergency rooms of French Regional Comprehensive Cancer Centers.
In the standard arm, patients will be managed regardless of their PALLIA-10 score, following conventional strategy. In the experimental arm, patients will be systematically referred to a palliative care team.
- Detailed Description
This is a randomized, multicenter, prospective, phase III study conducted in daily emergency rooms of French Regional Comprehensive Cancer Centers.
All patients undergoing a visit in the daily emergency room of a participating center and who need for palliative management (PALLIA 10 score \> 3/10) will be considered for inclusion in the PALLU study. After signing the written informed consent, patients will be randomized (1:1 ratio) in one of the following arms:
* Standard arm : conventional strategy; patients will be managed regardless of their PALLIA-10 score. The need for additional care, including palliative care, will be assessed by the team in charge of the patient, as per routine practice.
* Experimental arm : experimental strategy; patients will be systematically referred to a palliative care team.
Randomization will be stratified according to the investigation center and pre-existing follow-up by pain management team.
The difference of intervention will lie in the fact that patients will be referred or not to a palliative care team but patients from the standard arm may receive palliative care as deemed necessary by the medical oncology team. In this case, the content of palliative care for patients included in both groups will be identical.
The end of the study will be the Last Patient Last Visit (LPLV), defined as the date of the 12-month visit of the last patient still alive or when the 192nd death has occurred, whichever occurs first.
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 240
- Male or female ≥ 18 years at the day of consenting to the study;
- Confirmed diagnosis of any type of solid or haematology tumours, with or without Current oncological treatment, such as chemotherapy, immunotherapy, targeted therapy, etc;
- Unscheduled admission in a French Regional Comprehensive Anti-Cancer Centre due to an acute, unpredictable, intercurrent event related to cancer, its therapies or a comorbidity;
- Patient for whom disease is considered as not curable;
- PALLIA-10 Score > 3/10;
- Willingness and ability to comply with the study requirements;
- Signed and dated informed consent indicating that the patient has been informed of all the aspects of the trial prior to enrolment;
- Patient must be covered by a medical insurance.
- Patient without consciousness, unable to provide a written informed consent (context of emergency);
- Patient treated with a curative intent;
- Previous randomization in this clinical study;
- Patients already followed-up by a palliative care team;
- Life expectancy shorter than 1 month, as per the emergency units' staff judgement.
- Any medical or psychosocial condition that would compromise the patient's compliance to the study visits or would likely interfere with the completion of Patient-Reported Outcomes.
- Patients under tutorship or curatorship.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Experimental Systematic referral to a palliative care team Experimental strategy: patients will be systematically referred to a palliative care team.
- Primary Outcome Measures
Name Time Method Aggressiveness of care near the end of life From date of randomization until the date of death from any cause, assessed up to 30 months Percentage and number of patients who meet at least one of the following criteria :
* More than 1 hospitalization in the last 30 days of life;
* More than 1 visit in an emergency unit in the last 30 days of life;
* More than 14 days in hospital in the last 30 days of life;
* Hospitalization in a resuscitation unit in the last 30 days of life;
* Treatment with systemic anticancer therapy in the last 14 days of life;
* New systemic anticancer therapy regimen starting in the last 30 days of life;
* Patients dying in an acute care setting.
- Secondary Outcome Measures
Name Time Method More than 1 hospitalization in the last 30 days of life From date of randomization until the date of death from any cause, assessed up to 48 months Percentage and number of patients having more than 1 hospitalization in the last 30 days of life
Death in an acute care setting At the date of death from any cause, assessed up to 30 months Percentage and number of patients dying in an acute care setting
Medical resources mobilized in terms of palliative care From date of randomization until the date of death from any cause, assessed up to 30 months Medical resources mobilized in terms of palliative care (psychologist, social worker, nutritional counselling, etc.) will be described for the interventional group in terms of number and percentage of patients with at least one consultation with each specialist
Health-related quality of life using the HADS At inclusion, 3 months, 6 months, 9 months and at 12 months One score is generated for anxiety and one score for depression on a 0 to 21 points, with a higher score indicates higher level of trouble. Scores will be described per randomized group at each measurement time (inclusion,3 months and 6 months) using same criteria as for other quantitative variables (number of observations, mean, standard deviation, median, minimum and maximum values). Number and percentage of patients without anxiety or depression trouble (i.e. with a score of 7 or lower), moderate trouble (score between 8 to 10) and severe trouble (score of 11 or more) will be reported.
Hospitalization in a resuscitation unit in the last 30 days of life From date of randomization until the date of death from any cause, assessed up to 30 months Percentage and number of patients having a hospitalization in a resuscitation unit in the last 30 days of life
Treatment with chemotherapy in the last 14 days of life From date of randomization until the date of death from any cause, assessed up to 30 months Percentage and number of patients having a treatment with chemotherapy in the last 14 days of life
New chemotherapy regimen starting in the last 30 days of life From date of randomization until the date of death from any cause, assessed up to 30 months Percentage and number of patients having a new chemotherapy regimen starting in the last 30 days of life
Health-related quality of life using the FACT-G7 cancer specific questionnaire At inclusion, 3 months, 6 months, 9 months and at 12 months The total score ranges from 0 and 28, with a higher score indicates better quality of life. Scores will be described per randomized group at each measurement time (inclusion,3 months and 6 months) using same criteria as for other quantitative variables (number of observations, mean, standard deviation, median, minimum and maximum values).
Place of death At the date of death from any cause, assessed up to 30 months Hospital and type of unit or home will be described per randomized group
More than 1 visit in an emergency unit in the last 30 days of life From date of randomization until the date of death from any cause, assessed up to 30 months Percentage and number of patients having more than 1 visit in an emergency unit in the last 30 days of life
More than 14 days in hospital in the last 30 days of life From date of randomization until the date of death from any cause, assessed up to 30 months Percentage and number of patients having more than 14 days in hospital in the last 30 days of life
Overall Survival At the date of death from any cause, assessed up to 30 months Defined as the time from the date of inclusion to the date of death due to any cause.
Symptoms of cancer disease using the Edmonton Symptoms Assessment System (ESAS) symptom scores From date of randomization until the date of death from any cause, assessed up to 30 months Pain, tiredness, drowsiness, nausea, lack of appetite, depression, anxiety, shortness of breath, and wellbeing and patient-specific symptoms are each described on a scale ranging from 0 to 10 (10 being the worst). The mean change in symptoms will be estimated from baseline and at each follow-up time. The ESAS symptom scores will be calculated according to the authors' recommendations and described per randomized group at each time point by mean, standard deviation, median and range.
Trial Locations
- Locations (12)
Centre Léon Bérard
🇫🇷Lyon, France
Institut Gustave Roussy
🇫🇷Villejuif, France
Institut Curie - Paris
🇫🇷Paris, France
ICM Val d'Aurelle
🇫🇷Montpellier, France
Institut Curie - Saint Cloud
🇫🇷Saint-Cloud, France
Institut de Cancérologie de Lorraine
🇫🇷Vandœuvre-lès-Nancy, France
Institut Curie - Paris
🇫🇷Paris, France
Institut de Cancérologie de Lorraine
🇫🇷Vandœuvre-lès-Nancy, France
Centre Léon Bérard
🇫🇷Lyon, France
ICM Val d'Aurelle
🇫🇷Montpellier, France
Institut Curie - Saint Cloud
🇫🇷Saint-Cloud, France
Institut Gustave Roussy
🇫🇷Villejuif, France