Evaluation of the Implementation of an Early Integrated Palliative Care Program in the Esophageal Cancer Population
Palliative care physicians and nurses are trained to help reduce suffering and improve
quality of life in patients under their care. Their services also include other components
such as referral to dietitians, social workers and community resources, to assist patients
in their homes. In addition to this, they may also administer interventions to make patients
more comfortable, assisting them and their families in making important decisions and
providing support, during that time.
At present, palliative care is provided to esophageal cancer patients on an as-needed basis,
through the referral of a heath care professional or the patient's request. This study aims
to assess the impact of the integration of early palliative care combined with appropriate
medical care in the metastatic esophageal cancer population, so that patients can benefit
from these services at an earlier stage. It is hoped that this will improve quality of life,
symptom management, depression and anxiety, as well as survival.
- Esophageal cancer-specific symptom score
- Esophageal cancer-specific symptom management score
- Anxiety Score
- Depression Score
- Total duration of time from date of metastatic diagnosis to date of death
Previous reports suggest that starting palliative care early in patients with breast,
colorectal, prostate and lung cancers appear to improve quality of life, symptom management,
depression, anxiety and perhaps even survival, but it has never been tested in patients with
esophageal cancer.This study aims to assess the impact of the introduction of early
palliative care services on the esophageal cancer population, as opposed to traditional
palliative care, which is provided on an as-needed basis, usually in end-of-life situations.
The study is a prospective randomized control trial, where two arms will be assembled.
Eligible patients that have consented will be randomized to either the early palliative care
group (experimental arm) or standard palliative care group (control arm). The control arm
will be administered appropriate oncological care including surgical, brachytherapy,
chemotherapy or radiation therapy services. The palliative service will be involved only if the
patient, caregiver or physician involved in the oncological care requests a referral.
Alternatively, the intervention arm will consist of patients referred to the palliative
service at the time of randomization, with a consultation taking place within one week of
randomization. The nurses and physicians involved in the palliative service will not only
provide symptom management, psychosocial support, assistance with treatment related
decisions and other patient needs. Information about symptoms, anxiety and depression, and
quality of life will be collected through surveys at two timepoints - at baseline, when the
patient consents and at 12 weeks post diagnosis of metastatic disease. The primary outcome
of the study is the change in quality of life perceived by esophageal cancer patients at the
two timepoints. Secondary outcomes include differences in esophageal cancer specific
symptoms and anxiety and depression scores at the two timepoints, as well as patient
This study is integrated into the currently operational Esophageal Diagnostic Assessment
Program (EDAP) conceptualized and implemented at St. Joseph's Healthcare Hamilton. It is
hoped that this study will also help to establish the full integration of palliative care
into the overall care of patients with esophageal cancer.
View this trial on ClinicalTrials.gov