Impact of early palliative care on caregivers of patients with advanced cancer: cluster randomised trial.
Early palliative care improves the quality of life (QoL) and satisfaction with care of patients with advanced cancer, but little is known about its effect on caregivers. Here, we report outcomes of caregiver satisfaction with care and QoL from a trial of early palliative care.



Twenty-four medical oncology clinics were cluster-randomised, stratified by tumour site (lung, gastrointestinal, genitourinary, breast and gynaecological), to early palliative care team referral, or to standard oncology care with palliative care only as needed. Caregivers of patients with advanced cancer (clinical prognosis of 6-24 months, Eastern Cooperative Oncology Group 0-2) in both trial arms completed validated measures assessing satisfaction with care (FAMCARE-19) and QoL [SF-36v2 Health Survey; Caregiver QoL-Cancer (CQoL-C)], at baseline and monthly for 4 months. We used a multilevel linear random-intercept mixed-effect model to test whether there was improvement in the intervention group relative to the control group over 3 and 4 months.



A total of 182 caregivers completed baseline measures (94 intervention, 88 control); 151 caregivers (77 intervention, 74 control) completed at least one follow-up assessment. Satisfaction with care improved in the palliative intervention group compared with controls over 3 months (P = 0.007) and 4 months (P = 0.02). There was no significant improvement in the intervention group compared with controls for CQoL-C (3 months: P = 0.92, 4 months: P = 0.51), Physical Component Summary of the SF-36v2 Health Survey (3 months: P = 0.83, 4 months: P = 0.20), or Mental Component Summary of the SF-36v2 Health Survey (3 months: P = 0.87, 4 months: P = 0.60).



Early palliative care increased satisfaction with care in caregivers of patients with advanced cancer.



NCT01248624.
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.|Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.
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McDonald
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
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Swami
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.|Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.
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Hannon
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.|Department of Psychiatry, University of Toronto, Toronto, Canada.
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Lo
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
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Pope
Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.|Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
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Oza
Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.|Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
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Leighl
Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.|Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
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Krzyzanowska
Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.|Department of Psychiatry, University of Toronto, Toronto, Canada.|Campbell Family Research Institute, Toronto, Canada
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Rodin
Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
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Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.|Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Canada.|Department of Psychiatry, University of Toronto, Toronto, Canada.|Campbell Family Research Institute, Toronto, Canada
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Zimmermann
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D011795:Surveys and Questionnaires
advanced cancer; caregivers; palliative care; quality of life; randomised controlled trial; satisfaction with care