한빛사논문
- 조회210
EunKyo Kang, MD1,2; Jung Hun Kang, MD3; Su-Jin Koh, MD4; Yu Jung Kim, MD5; Seyoung Seo, MD6; Jung Hoon Kim, MD3; Jaekyung Cheon, MD7; Eun Joo Kang, MD8; Eun-Kee Song, MD9; Eun Mi Nam, MD10; Ho-Suk Oh, MD11; Hye Jin Choi, MD12; Jung Hye Kwon, MD13,14,15; Woo Kyun Bae, MD16; Jeong Eun Lee, MD13; Kyung Hae Jung, MD6; Young Ho Yun, MD17,18
1National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea
2Department of Family Medicine, National Cancer Center, Goyang, Republic of Korea
3Department of Internal Medicine, Gyeongsang National University, Jinju, Republic of Korea
4Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine, Ulsan, Republic of Korea
5Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
6Department of Oncology, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
7Department of Hemato-Oncology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
8Department of Hemato-Oncology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Republic of Korea
9Department of Internal Medicine, Jeonbuk National University Medical School, Jeonju, Republic of Korea
10Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
11Division of Hemato-Oncology, Department of Internal Medicine, GangNeung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
12Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
13Department of Internal Medicine, College of Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
14Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
15Daejeon Regional Cancer Center, Daejeon, Republic of Korea
16Division of Hematology-Oncology, Department of Internal Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, Republic of Korea
17Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
18Department of Human System Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
Drs E. Kang and J. H. Kang contributed equally to this work as co–first authors.
Corresponding Author: Young Ho Yun, MD, PhD
Abstract
Importance: Limited data suggest that early palliative care (EPC) improves quality of life (QOL) and survival in patients with advanced cancer.
Objective: To evaluate whether comprehensive EPC improves QOL; relieves mental, social, and existential burdens; increases survival rates; and helps patients develop coping skills.
Design, setting, and participants: This nonblinded randomized clinical trial (RCT) recruited patients from 12 hospitals in South Korea from September 2017 to October 2018. Patients aged 20 years or older with advanced cancer who were not terminally ill but for whom standard chemotherapy has not been effective were eligible. Participants were randomized 1:1 to the control (receiving usual supportive oncological care) or intervention (receiving EPC with usual oncological care) group. Intention-to-treat data analysis was conducted between September and December 2022.
Interventions: The intervention group received EPC through a structured program of self-study education materials, telephone coaching, and regular assessments by an integrated palliative care team.
Main outcomes and measures: The primary outcome was the change in overall QOL score (assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care) from baseline to 24 weeks after enrollment, with evaluations also conducted at 12 and 18 weeks. Secondary outcomes were social and existential burdens (assessed with the McGill Quality of Life Questionnaire) as well as crisis-overcoming capacity and 2-year survival.
Results: A total of 144 patients (83 males [57.6%]; mean [SD] age, 60.7 (7.2) years) were enrolled, of whom 73 were randomized to the intervention group and 71 to the control group. The intervention group demonstrated significantly greater changes in scores in overall health status or QOL from baseline, especially at 18 weeks (11.00 [95% CI, 0.78-21.22] points; P = .04; effect size = 0.42). However, at 12 and 24 weeks, there were no significant differences observed. Compared with the control group, the intervention group also showed significant improvement in self-management or coping skills over 24 weeks (20.51 [95% CI, 12.41-28.61] points; P < .001; effect size = 0.93). While the overall survival rate was higher in the intervention vs control group, the difference was not significant. In the intervention group, however, those who received 10 or more EPC interventions (eg, telephone coaching sessions and care team meetings) showed a significantly increased probability of 2-year survival (53.6%; P < .001).
Conclusions and relevance: This RCT demonstrated that EPC enhanced QOL at 18 weeks; however, no significant improvements were observed at 12 and 24 weeks. An increased number of interventions sessions was associated with increased 2-year survival rates in the intervention group.
논문정보
- Research article
- 2024년 08월 (BRIC 등록일 2024-08-09)
- 국내 연구진
- 의약학 > 종양의학
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