Dey Treshita, Mukerjee Anindya, Rai Bhavana, Arora Minni, Kumar Divyesh, Srinivasa G Y, Ghoshal Sushmita
Department of Radiotherapy and Oncology, PGIMER Chandigarh, New Delhi, India.
Department of Medical Oncology, Rajiv Gandhi Cancer Institute and Research Centre, New Delhi, India.
J Family Med Prim Care. 2023 Feb;12(2):366-370. doi: 10.4103/jfmpc.jfmpc_1569_22. Epub 2023 Feb 28.
Palliative care (PC) has been classically synonymous with end-of-life care offered to patients with advanced incurable cancers with an aim to improve their quality-of-life (QoL). However, there is growing evidence to suggest that early integration of PC (EIPC) along with cancer-directed management improves patient-reported outcomes. In this study, we aim to evaluate the impact of EIPC on QoL of cervical cancer patients treated with curative intent.
Patients with locally advanced cervical cancer (stage IB2 to IIIB) having eastern cooperative oncology group (ECOG) performance score 0-2 were randomized into EIPC arm and standard of care arm of concurrent chemoradiation by a computer-generated table of random numbers. QoL was assessed by functional assessment of cancer therapy - general (FACT-G) questionnaire twice in both arms. The first assessment was done prior to starting treatment and second assessment at three months after treatment completion. The mean scores on physical, mental, emotional, social, and functional well-being subscales of FACT-G scale were calculated in both arms, and Wilcoxon test was used to evaluate differences in QoL scores within and in between the arms. This trial was registered with Clinical Trials Registry of India (CTRI) vide CTRI/2017/05/008704.
Fifty patients were enrolled in each arm. However, only 42 and 45 patients in EPIC and standard oncological care arm were evaluated in the final analysis. Comparing QoL scores between the two time points in each arm, the mean pre-treatment scores in EIPC arm was significantly higher than post-treatment scores in the domains of physical and emotional well-being, whereas social and functional well-being scores improved significantly after treatment as compared with that as baseline. However, when compared between two arms, the difference of mean scores pre- and post-treatment were almost similar for physical and functional well-being but statistically significant differences were found only in social and emotional well-being scales.
Our study is a feasibility study done in an attempt to test the validity of EIPC in cervical cancers. The results are inspiring to conduct robust studies in the future to explore this new domain of integration of palliative services in curable cancers.
姑息治疗（PC）传统上一直等同于为晚期不治之症癌症患者提供的临终关怀，旨在提高他们的生活质量（QoL）。然而，越来越多的证据表明，将姑息治疗早期整合（EIPC）与针对癌症的治疗相结合可改善患者报告的结局。在本研究中，我们旨在评估EIPC对接受根治性治疗的宫颈癌患者生活质量的影响。
东部肿瘤协作组（ECOG）体能状态评分为0 - 2分的局部晚期宫颈癌（IB2期至IIIB期）患者，通过计算机生成的随机数字表随机分为EIPC组和同步放化疗的标准治疗组。两组均使用癌症治疗功能评估通用问卷（FACT - G）对生活质量进行两次评估。第一次评估在开始治疗前进行，第二次评估在治疗完成后三个月进行。计算两组FACT - G量表在身体、心理、情感、社会和功能健康子量表上的平均得分，并使用Wilcoxon检验评估组内和组间生活质量得分的差异。本试验已在印度临床试验注册中心（CTRI）注册，注册号为CTRI/2017/05/008704。
每组招募了50名患者。然而，最终分析中EIPC组和标准肿瘤治疗组分别仅评估了42例和45例患者。比较每组两个时间点的生活质量得分，EIPC组治疗前在身体和情感健康领域的平均得分显著高于治疗后得分，而社会和功能健康得分与基线相比在治疗后显著改善。然而，两组之间比较时，身体和功能健康方面治疗前后平均得分的差异几乎相似，但仅在社会和情感健康量表上发现有统计学意义的差异。
我们的研究是一项可行性研究，旨在检验EIPC在宫颈癌中的有效性。研究结果鼓舞人心，未来可开展更有力的研究来探索在可治愈癌症中整合姑息服务这一新领域。
