E391: Who Benefits from Specialist Palliative Care among Patients Undergoing Major Abdominal Surgery for Cancer?: Subgroup Analysis of the Surgery for Cancer with Option of Palliative Expert (SCOPE) Trial

Specialist palliative care (SPC) improves outcomes among patients undergoing medical treatment for cancer. Current guidelines recommend SPC for patients with advanced cancer, many of whom will undergo surgery during cancer treatment. Recent randomized controlled trials (RCTs) of broad surgical oncology populations have failed to show a benefit of SPC. We performed a secondary analysis of one such RCT to explore whether subgroups of surgical oncology patients benefit from SPC.

Methods:

Inclusion criteria were adult patients enrolled at a single institution undergoing 1 of 8 operations: gastrectomy, hepatectomy, pancreatectomy, colectomy or proctectomy, radical cystectomy, pelvic exenteration, CRS or CRS and HIPEC. Palliative operations were excluded. Patients were randomized to receive usual care or an SPC intervention initiated preoperative and continued for 90 days postoperatively. Outcome assessments included 90-day quality of life per Functional Assessment of Cancer Therapy General (FACT-G) Trial Outcomes Index (TOI) and Total Score, Patient-Reported Outcome Measure Information System (PROMIS) Anxiety and Depression, and the Life Space Assessment. Effect modification analysis of the subgroups was performed with a significance level of 0.2.

Results:

235 patients were randomized 1:1 to SPC intervention v. usual care. On subgroup analysis, age was found to modify treatment effect for FACT-G TOI scores (p=0.12), PROMIS Anxiety (p=0.03), and PROMIS Depression (p=0.01), but not FACT-G Total Score (p=0.57) or Life Space Assessment (p=0.71). Baseline outcome score was found to modify effect for FACT-G TOI (p=0.04), PROMIS Anxiety (p=0.19), and Life Space Assessment (p=0.03). Surgery type was also found to modify effect for PROMIS Anxiety (p=0.008), PROMIS Depression (p=0.06), and Life Space Assessment (p=0.05). Frailty was not found to modify treatment effect for any of the five outcomes, and there was no dose-response association of total number of palliative care visits to outcomes.

Conclusions:

A subgroup analysis from an RCT of patients undergoing major nonpalliative cancer surgeries and randomized to SPC intervention v. usual care, there were no consistent subgroups that experienced benefits or harms based on 5 outcomes. Further research is warranted to delineate surgical oncology subgroups most likely to benefit from SPC and how to optimally deliver it in the perioperative period of overall cancer treatment.