Background: Integration of early palliative care (EPC) in oncology improves quality of life (QoL) and symptom burden. However, directing EPC to patients most likely to benefit may be more cost-effective and time-efficient than universal implementation.

Aims: To determine predictors of outcome improvement at 4 months among patients with advanced cancer receiving EPC in a cluster randomized controlled trial (RCT).

Methods: We performed a secondary analysis of data from the treatment arm of an RCT conducted between December 1, 2006 and February 28, 2011. Data on demographic factors, treatment status, and ECOG score were collected at baseline. Participants completed measures at baseline and 4 months to assess QoL (Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being [FACIT-Sp] and Quality of Life at the End of Life [QUAL-E]), symptom severity (Edmonton Symptom Assessment System Distress Score [ESAS-EDS], and satisfaction with care (FAMCARE-P16). Multivariable regression analyses were conducted to determine baseline factors associated with improvement at 4 months.

Results: A total of 131 patients in the EPC arm completed 4 month measures. Improvement in FACIT-Sp was associated with worse baseline ESAS-EDS (beta=0.29, p=0.001). Improvement in ESAS was also associated with worse baseline ESAS-EDS (beta=0.59, p< 0.0001). FAMCARE scores improved most in those living alone (beta=3.90, p=0.03) and not receiving active chemotherapy (beta=4.30, p=0.03). There was no factor significantly associated with improvement in QUAL-E. These outcomes were not affected by age, sex, primary tumour site, or education or employment status.

Conclusion: Patients with greater symptom burden were most likely to demonstrate improvement in QoL and symptoms following EPC, while those with greater social support needs had the greatest improvement in satisfaction with care. Prioritizing such patients may be a cost-effective and time-efficient approach to early palliative care.

Funding: Canadian Cancer Society and Canadian Institute of Health Research

Factors Associated with Improvement in Patient-reported Outcomes after Receiving Early Palliative Care