Researchers have developed a screening method that helped distinguish which patients with advanced cancer remained stable without early palliative care (EPC) and those who benefited from EPC.

The researchers described the method, called “Symptom screening with Targeted Early Palliative care (STEP),” in the Journal of the National Comprehensive Cancer Network.

The researchers tested STEP in a phase 2 study of 116 patients with advanced cancers, including lung, gastrointestinal, genitourinary, breast, and gynecologic malignancies.

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STEP involved assessing patients’ symptoms at every outpatient visit using the revised Edmonton Symptom Assessment System (ESAS-r). Patients with moderate to severe ESAS-r scores were offered EPC.

The majority of patients (77%) completed screening for at least 70% of their visits.

In all, there were 70 patients with moderate to severe ESAS-r scores who were offered EPC. More than half of this group (56%) received EPC during the 6-month study, and 6% received EPC after the study ended.

The most common reasons for declining EPC were that patients’ symptoms improved or were adequately managed, patients felt overburdened by appointments, or they were not interested in EPC.

The patients who ultimately received EPC saw improvements in symptom control and mood over time, while patients with moderate to severe ESAS-r scores who did not receive EPC had declines in mood and symptom control (P <.01 for trend over time).  

At baseline, patients with low ESAS-r scores had significantly better quality of life, depression, and symptom control than did patients with moderate to severe ESAS-r scores (P <.001 for all). These parameters remained stable over time for the patients with low ESAS-r scores.

“STEP identified those who were most likely to benefit from early palliative care and indicated improvements in those who attended the targeted early palliative care visit compared with those who declined early palliative care,” the researchers wrote. “Based on these findings, a multicenter, randomized trial of STEP versus standard palliative care in patients with advanced cancer is underway.”

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Zimmerman C, Pope A, Hannon B, et al. Phase II trial of symptom screening with targeted early palliative care for patients with advanced cancer. J Natl Canc Netw. Published online September 7, 2021. doi:10.6004/jnccn.2020.7803