“In the ENABLE III study reported in the Journal of Clinical Oncology, Bakitas et al found that early vs delayed initiation of a palliative care intervention did not result in improved patient-reported outcomes or resource use. Early initiation was associated with better 1-year survival.
“In the trial, 207 patients with advanced cancer from the Norris Cotton Cancer Center, affiliated outreach clinics, and the VA Medical Center in New Hampshire and Vermont were randomly assigned between October 2010 and March 2013 to receive an in-person palliative care consultation, structured telehealth nurse coaching sessions (once per week for six sessions), and monthly follow-up either early after enrollment (n = 104) or 3 months later (n = 103). Outcomes were quality of life, symptom impact, mood, 1-year survival, and resource use (hospital/intensive care unit days, emergency room visits, chemotherapy in last 14 days, and death location). Quality of life was assessed by the Functional Assessment of Chronic Illness Therapy-Palliative Care scale and Treatment Outcome Index, symptom impact by the Quality of Life at End of Life symptom impact subscale, and mood by the Center for Epidemiologic Studies-Depression scale.
“The early and delayed groups did not significantly differ with regard to age, gender, marital status, race/ethnicity, religion, attendance of religious services, praying for own health, work status, medical insurance, ever smoked status, current smoking status, percent with caregiver enrolled in the study, rural residence, cancer diagnoses, disease status at enrollment, brain metastases, chemotherapy or radiotherapy at enrolment, Charlson comorbidity score, Karnofsky performance status, living will/durable power of attorney or do not resuscitate order, or referral to hospice. The early group had a higher education level (P = .05), higher alcoholic beverage consumption per week (P = .04), and a greater proportion of patients enrolled in a clinical trial (18% vs 8%, P = .04). Among former smokers, there was a borderline significant trend (P = .06) for history of fewer cigarettes per day in the delayed group.”