Abstract A42: A nurse practitioner-directed palliative care intervention trial in racially diverse patients with metastatic cancer.
Authors: Colon-Otero Gerardo , Lesperance Mary , Rana Fauzia , Shannon Robert , Sloan Jeffrey 
Published: August 2014

Background: Several randomized trials had shown the benefits of palliative care interventions in patients with metastatic cancer. However, there is a paucity of data evaluating the benefit of palliative care in racially diverse patient populations, and no systematic analysis of the effect of race/ethnicity on these interventions have been done. Recently, our group completed a randomized clinical trial showing that an Advanced Registered Nurse Practitioner (ARNP)-directed palliative care intervention for patients with metastatic cancer leads to improvement in the patients' emotional quality of life (EQoL) as determined by a validated quality of life tool, the FACT-G (PAL-1 study, Dyar et al: J Palliative Medicine 15: 890, 2012). The PAL-2 pilot study reported herein evaluated the feasibility of this program in underserved racially diverse patient populations. PAL-2 incorporated PAL-1 interventions of advanced directives discussions, hospice services education and assessment of QoL using the FACT-G tool. In addition, the PAL-2 program incorporated home visits and implementation of FACT-G driven palliative interventions.

Aims: The primary endpoint was to assess the feasibility of an ARNP-directed palliative care intervention trial for racially diverse cancer patients. The ultimate goal was to use the data from this pilot study to plan for a subsequent larger randomized trial. Secondary end points included evaluation of the effects of the intervention on the patient's QoL and emotional well-being as determined by a change in FACT-G , EQoL scores, as well as measurement of knowledge about hospice as determined by changes in a hospice knowledge questionnaire (HKQ) scores.

Methods: 25 adult patients with metastatic cancer were recruited. All patients completed a FACT-G and a HKQ at baseline, had an ARNP consultation, and a home visit whenever feasible, with a second ARNP consultation visit 4 weeks later.

Results: Of 25 patients who participated (16 males, 9 females, mean age 57, age range 33-89, 16 Caucasians (C), 8 African Americans (AA), 1 Asian), 15 patients (8C, 7AA) completed their first and second ARNP consultation visits and 12 (5C, 7AA) completed all questionnaires and were available for secondary endpoint analysis. The main reason for failure to complete the study was disease progression. The most common interventions implemented were advanced directives discussions, assessment of family support, stress management education, assessment of psychological status, spirituality assessment, financial assistance programs, and pain and symptom management. Interventions offered but not selected by most patients included: use of computer based social networking tools, psychological interventions, occupational training and cancer support group participation. Home visits were completed in 11 patients and provided significant insight into the patients' needs and their available support. The palliative care intervention and the FACT-G tool were well accepted by patients. There was no significant change in the EQoL as a result of the intervention ( EQoL change, mean (SD)= -1.2 (13.52), median 3.7, p=0.6719). A trend was observed towards improvement in HKQ results (n=8, change from baseline score mean (SD)= 21.2 (29.58), median 15.4, p= 0.0938).

Conclusions: The FACT-G tool was well received by the patients and providers, and its use can be incorporated into clinical care to direct palliative care interventions and assess their impact on patients' QoL. A nurse practitioner-directed palliative care intervention is well accepted by patients of diverse race. Significant attrition of participants due to disease progression (40%) will need to be considered in planning larger randomized trials. Randomized clinical trials evaluating the impact of race, ethnicity and socio-economic status on the benefits of different palliative care interventions in patients with metastatic cancer are feasible and needed.

Citation Format: Gerardo Colon-Otero, Mary Lesperance, Fauzia Rana, Robert Shannon, Jeffrey Sloan. A nurse practitioner-directed palliative care intervention trial in racially diverse patients with metastatic cancer. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A42.