Impact of Early Palliative Care 6 Months After Major Abdominal Surgery for Cancer

INTRODUCTION: The Surgery for Cancer with Option of Palliative Care Expert randomized clinical trial showed no evidence that a specialist palliative care intervention improved 90-d postoperative outcomes in patients undergoing surgery for cancer. Effects at 6 mo postoperatively have not been evaluated. METHODS: This was a prospective, single-center randomized clinical trial performed from 2019 to 2021. Patients undergoing nonpalliative surgery of an intra-abdominal malignancy were enrolled. The intervention group received usual care plus early specialist palliative care preoperatively and postoperatively. The prespecified secondary outcome was Post-traumatic stress disorder (PTSD) symptoms measured by the PTSD Checklist-Civilian Version 180 d postoperatively. Exploratory outcomes included post-traumatic growth, anxiety, depression, and life-space. RESULTS: In 235 included patients, PTSD symptoms did not differ significantly at 180 d postoperatively (intervention versus usual care adjusted odds ratio [OR], 1.16; 95% confidence interval, 0.70-1.93) nor did post-traumatic growth (OR, 0.96; 95% CI, 0.71-1.31). The intervention group had lower anxiety (OR, 0.59; 95% CI, 0.36-0.96) and depression (OR, 0.57; 95% CI 0.35-0.94) and larger life-space (OR, 1.69; 95% CI, 1.16-2.46). However, the differences in adjusted median scores for these exploratory outcomes were small and less than the minimal clinically important difference for these measures. CONCLUSIONS: This study found no difference in the prespecified secondary outcome and small differences of unclear clinical significance in three exploratory outcomes favoring early palliative referral among patients undergoing surgery for cancer. However these results should be interpreted cautiously and do not justify the routine deployment of scarce palliative care resources in the perioperative setting.