Early integration of palliative home care in standard oncological treatment of patients with advanced cancer
Patients with advanced and incurable cancer typically suffer from a multitude of severe symptoms that often appear underdiagnosed and/or undertreated such as pain, dyspnea and depression. At the same time, in order to keep the hope of recovery alive, these patients often receive continued life-prolonging yet burdensome treatment with marginal or nonexistent benefit or even adverse effects. Palliative care, defined as ‘an approach that improves the quality of life of patients and their families facing life-threatening illness through prevention and relief of symptoms’ (WHO definition), is an approach that can mitigate these problems, but is typically only provided late in the course of the disease, when death is imminent. Recent studies have shown that offering palliative care early on – e.g. from diagnosis of advanced cancer – and integrated into the oncological treatment has beneficial effects on the patient’s quality of life and even survival time. Integrating palliative home care in standard oncological treatment constitutes a challenging and wholely new approach to the treatment and care of advanced cancer patients. It is more complex than the existing integration models and is likely to involve changes at all levels of the health care system, from health care professionals to policy makers. However, there are potentially very important benefits for the patients.
The overall objective of this study is to develop and evaluate a totally new model of integration of early palliative home care in standard oncological treatment in Flanders, Belgium, in order to significantly improve the quality of life of patients with advanced cancer.
The intervention will be conducted following the steps and latest insights of the Medical Research Council framework for development and evaluation of complex interventions using mixed methodology. We aim to complete phase 0 to phase 2 in this study. Phases 0-1 comprise the development of the early palliative home care intervention by theory and modelling. We will research the literature to identify existing and tested models, and we will organize focus groups and interviews with patients and health care professionals to examine the barriers and facilitators of integration of early palliative home care in standard oncological treatment. Evaluation of the integration model developed in phase 1 will be done through a phase 2 trial. This phase 2 trial will have a multicenter randomized controlled (intervention group vs. control group) study design. Patients diagnosed with advanced cancer of the lung, breast and gastrointestinal tract and with an estimated life expectancy of < 1.5 years will be recruited by oncologists from the medical oncology department of the university hospital in the Brussels region and will be followed up by the palliative home care team, Omega vzw.
Naomi Dhollander: researcher
Prof. dr. Koen Pardon: supervisor
Prof. dr. Luc Deliens: promotor
Prof. dr. Simon Van Belle: co-promotor
Dr. Aline De Vleminck: member