Patients with cancer dually enrolled in palliative care programs and phase 1 clinical trials face unique ethical considerations. Opportunities to incorporate palliative care into these patients’ treatment regimens could improve quality of life, according to a poster presentation that urged further exploration of this subject at the Oncology Nursing Society (ONS) 44th Annual Congress, held in Anaheim, California.
Most oncology health care providers agree that there is a need to establish palliative care as a facet of the initiation of therapy for patients with cancer, however as it currently stands most patients are referred closer to the end of their life.
Organizations, such as the National Comprehensive Cancer Network (NCCN) and the Institute of Medicine (IOM), have established initiatives that promote earlier implementation of palliative care programs. These initiatives, however, do not include recommendations for patients with cancer enrolled in phase 1 clinical trials. The researcher highlight that because many patients enrolled in phase 1 clinical trials are nearing end of life and at an important stage within their care continuum, there are ethical and moral challenges for clinicians and investigators to consider for this patient population in particular.
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Amanda Brock RN, MSN, MBE, OCN®, of Penn Medicine in Philadelphia, Pennsylvania, suggests the incorporation of a palliative care consultation into the enrollment process for phase 1 trials. She defines the goals of such a consultation as relieving the burden of establishing appropriate palliative care from the principal investigator; improving the quality of life for patients; expanding the proportion of trial participants who undergo planning discussions on advanced care; reducing the costs of aggressive end-of-life care; and providing a smoother continuum of care after trial withdrawal.
Furthermore, the Ms Brock indicates the potential benefits of integrating a palliative care consultation include longer duration on clinical trials; longer overall survival; and higher rates of completed advance directives.
To assess the palliative care consultation at phase 1 clinical trial enrollment, the presenter suggests metrics such as assessing rates of use of palliative care during trial experience; measuring the proportion of patients who receive care aligned with their desires; and determining patient experience.
Reference
Brock A. The role of palliative care in phase 1 clinical trial participants. Poster presentation at: ONS 44th Annual Congress; April 11-14, 2019; Anaheim, CA.
This article originally appeared on Oncology Nurse Advisor
