Effects of Early Palliative Care Involvement on More At-Risk Patients Undergoing Surgery for Cancer

Introduction

Two recent clinical trials of patients undergoing nonpalliative surgery for abdominal malignancies found no benefit from early specialist palliative intervention. However, more at-risk patients may benefit from this intervention.

Methods

This secondary, post-hoc exploratory analysis of data from one of these trials examines heterogeneity of treatment effect to identify at-risk subgroups of patients who benefit from early specialist palliative intervention. Regression models with interaction terms between treatment and age, frailty, and baseline values of patient reported outcomes (PROs) were used to examine heterogeneity of treatment effect for five PROs at 90 d postoperatively.

Results

At alpha = 0.2, there was evidence of possible heterogeneity of treatment effect in six models: by age for the outcomes of physical and functional quality of life (P = 0.12), anxiety (P = 0.03), and depression (P = 0.01); by baseline PRO value for the outcomes of physical and functional quality of life (P = 0.04), anxiety (P = 0.19), and life space (P = 0.03). Graphical examination did not reveal a consistent pattern of more positive intervention effects for more at-risk patients.

Conclusions

We found no consistent pattern in heterogeneity of effect to suggest a particular subgroup benefitting from early specialist palliative intervention. This further supports the conclusion that the palliative care needs of these patients are met by their usual care teams.