Early Contact with Palliative Care Services: A Randomized Trial in Patients with Newly Detected Incurable Metastatic Cancer

Background: It is not known when in the course of incurable cancer referral to a specialist palliative care service should optimally be made. Methods: We randomly assigned patients with newly detected incurable metastatic cancer with an estimated survival of less than 12 months to receive either (1) standard oncologic care plus contact from a palliative care nurse who served as a link to palliative care services in the hospital and community (PC) or (2) standard oncologic care alone. Quality of life (QoL) measures were assessed at baseline and monthly thereafter. The primary endpoint was quality of life over time measured by the McGill QOL total score. Findings: 120 patients were randomized, 60 to each group. Forty four patients had gastrointestinal cancer, 23 lung cancer, 19 gynaecological cancer and 17 breast cancer. The mean time since initial cancer diagnosis was 34 months in the standard care group and 29 months in the early palliative care contact group. There was no evidence that early PC nurse contact reduced symptoms or improved quality of life. If anything, there was a trend towards the opposite. There were non-significant trends for the place of death of early contact PC patients to be other than in an acute hospital, and for greater PC input during their final acute hospital admission. Early contact with palliative care was not found to influence the number of lines of chemotherapy received. Interpretation: The study did not demonstrate a QoL benefit for early contact with a PC nurse.