Clinical Trial Participation as Part of End-of-Life Cancer Care:
Associations With Medical Care and Quality of Life Near Death.
J Pain Symptom Manage. 2013 Oct 5.
Source
Center for Psychosocial Epidemiology and Outcomes Research, Dana-Faber Cancer Institute, Boston, Massachusetts, USA; Department of Medical Oncology, Dana-Faber Cancer Institute, Boston, Massachusetts, USA; McGraw/Patterson Center for Population Sciences, Dana-Faber Cancer Institute, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.Abstract
CONTEXT:
Clinical trials are a common therapeutic option for patients with advanced incurable cancer.
OBJECTIVES:
To examine the associations between trial participation and end-of-life (EOL) outcomes, including aggressive care and quality of life (QOL).
METHODS:
Coping with Cancer, a multicenter prospective cohort study of patients with metastatic cancer,
progressed after at least first-line chemotherapy. Baseline chart
review documented clinical trial participation. Baseline interviews
assessed psychosocial characteristics and EOL preferences. Caregiver
interview and chart review assessed medical care and QOL near death. The primary outcome was aggressive EOL care (ventilation, resuscitation, or intensive care
unit admission in last week of life). Propensity score weighting
balanced patient characteristics that differed by trial participation,
including care
preferences and EOL discussion. Propensity score-weighted regression
models estimated the effect of trial participation on outcomes.
RESULTS:
Of
352 patients followed to death, 37 were enrolled in a clinical trial at
baseline. In propensity score-weighted analyses, trial participation
was significantly associated with aggressive EOL care
(21.6% vs. 12.0%, adjusted odds ratio [AOR] 2.04, 95% confidence
interval [CI] 1.00-4.15), late hospice enrollment (51.4% vs. 42.2%, AOR
1.96, 95% CI 1.10-3.50), hospital death (48.6% vs. 25.7%, AOR 2.74, 95%
CI 1.37-5.47), intensive care
unit death (16.2% vs. 6.3%, AOR 3.53, 95% CI 1.29-9.65), and inferior
QOL near death (least squares mean 5.93 vs. 7.69, P<0.001).
Controlling for EOL care, trial enrollment was no longer associated with QOL near death (P=0.342).
CONCLUSION:
Clinical trial participation is associated with aggressive EOL care. Aggressive EOL care appears to explain the association between trial participation and QOL near death.
Copyright © 2013 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved.
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