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Impact of early palliative care on additional line of chemotherapy in metastatic breast cancer patients: results from the randomized study OSS

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Abstract

Purpose

The most appropriate criteria and timing for palliative care referral remain a critical issue, especially in patients with metastatic breast cancer for whom long-term chemosensibility and survival are observed. We aimed to compare the impact of early palliative care including formal concertation with oncologists on decision for an additional line of chemotherapy compared with usual oncology care.

Methods

This randomized prospective study enrolled adult women with metastatic breast cancer and visceral metastases with a 3rd- or 4th-line chemotherapy (CT). Patients received usual oncology care with a palliative care consultation only upon patient or oncologist request (standard group, S) or were referred to systematic palliative care consultation including a regular concertation between palliative care team and oncologists (early palliative care group, EPC). The primary endpoint was the rate of an additional CT (4th or 5th line) decision. Quality of life, symptoms, social support and satisfaction were self-evaluated at 6 and 12 months, at treatment discontinuation or 3 months after discontinuation.

Results

From January 2009 to November 2012, two authorized cancer centers included 98 women (EPC: 50; S: 48). Thirty-seven (77.1%, 95%CI 62.7–88%) patients in the EPC group had a subsequent chemotherapy prescribed and 36 (72.0%, 95%CI 57.5–83.8%) in the S group (p = 0.646). No differences in symptom control and global quality of life were observed, but less deterioration in physical functioning was reported in EPC (EPC: 0 [− 53–40]; S: − 6; 7 [− 60 to − 20]; p = 0.027). Information exchange and communication were significant improved in EPC (exchange, EPC: − 8.3 [− 30 to + 7]; S: 0.0 [− 17 to + 23]; p = 0.024; communication, EPC: 12.5 [− 8 to − 37]; S: 0.0 [− 21 to + 17]; p = 0.004).

Conclusion

EPC in metastatic breast cancer patients did not impact the prescription rate of additional chemotherapy in patients a 3rd- or 4th-line chemotherapy for metastatic breast cancer; however, EPC may contribute to alleviate deterioration in physical functioning, while facilitating communication.

Trial registration

ClinicalTrial.gov identifier: NCT00905281, May 20, 2009.

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Data availability

Data supporting the findings of this study is available within the article, and from the corresponding author upon reasonable request.

Code availability

Not applicable.

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Acknowledgements

The authors thank Sophie DARNIS PhD (Centre Léon Bérard) for helpful comments and valuable help for medical editorial assistance.

Funding

Partial financial support was received from the French general direction of health care (PHRQ-2007), and Ligue contre le cancer (SHS 2010).

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Authors and Affiliations

  1. Supportive Care Department, Centre Léon Bérard, 28 rue Laennec, 69373, Lyon, France

    Gisèle Chvetzoff & Pierre Saltel

  2. University Claude Bernard, Lyon, France

    Gisèle Chvetzoff & Isabelle Ray-Coquard

  3. Supportive Care Department, Institut Curie, Paris, France

    Carole Bouleuc

  4. Department of Clinical Research and Innovation, Centre Léon Bérard, Lyon, France

    Audrey Lardy-Cléaud, Magali Morelle, Valérie Bourne-Branchu & David Pérol

  5. Medical Oncology Department, Institut Curie, Paris, France

    Véronique Dieras, Simona Pop, Jean-Yves Pierga, Laurent Mignot & Valérie Laurence

  6. Medical Oncology Department, Centre Léon Bérard, Lyon, France

    Jean-Paul Guastalla, Olivier Tredan, Paul Rebattu, Isabelle Ray-Coquard & Thomas Bachelot

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  1. Gisèle Chvetzoff
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Contributions

G. C., P. S., J. P. G., O. T., P. R. and D. P. contributed to the study conception and design. Data collection was performed by G. C., C. B., P. S., V. D., J. P. G., O. T., P. R., S. P., I. R-C, P-YP, L. M., V. L. and T. B. Data curation was performed by V. B. B., A. L-C. and M. M. did the data analysis and contributed together with G. C. to the interpretation. The first draft of the manuscript was written by G. C. G. C. and C. B. closely revised the manuscript, with all authors contributing to the final review and approval of the final manuscript.

Corresponding author

Correspondence to Gisèle Chvetzoff.

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Competing interests

The authors declare no competing interests.

Ethics approval

This study was conducted with the ethical standards as laid down in the Declaration of Helsinki and its last amendments or comparable ethical standards, the International Conference on Harmonization on Good Medical Practices after local approvals from the ethics committee (Lyon Sud-Est IV), the French advisory committee on information in health research (CCTITS) and the French data protection authority (Commission Nationale de l’Informatique et des Libertés, CNIL). All patients provided written informed consent before enrolment. This study was registered with ClinicalTrial.gov, number NCT00905281, registered on May 20, 2009.

Conflict of interest

The authors declare no competing interests.

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The funders had no role in the design, conduct, analysis or reporting of the trial.

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Chvetzoff, G., Bouleuc, C., Lardy-Cléaud, A. et al. Impact of early palliative care on additional line of chemotherapy in metastatic breast cancer patients: results from the randomized study OSS. Support Care Cancer 31, 82 (2023). https://doi.org/10.1007/s00520-022-07561-x

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