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Friday, May 13, 2016

Prospective, Interdisciplinary Randomized Clinical Trials for Patients With Cancer in the Emergency Department...



 Define:  verb (used with object), palliated, palliating. to relieve or lessen without curing; mitigate; alleviate.

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JAMA Network | JAMA Oncology | Prospective, Interdisciplinary Randomized Clinical Trials for Patients With Cancer in the Emergency Department:  A Step Forward for Palliative Oncology Care
 Editor's Note |

It is clear that the emergency department (ED) is a source of care for a considerable portion of the population, including patients experiencing acute and subacute effects of the underlying malignant disease or perhaps adverse effects of treatment.1 For those with advanced disease and/or symptoms requiring prompt palliation, it would seem intuitive to begin formal palliative care in the ED. In fact, ED practitioners offer end-of-life care management.2
Grudzen and colleagues3 from Mt Sinai and New York University are to be congratulated on their attempt to address this question in a prospective, randomized clinical trial.4 The investigators did show an improvement in quality of life as measured by the Functional Assessment of Cancer Therapy–General Measures (FACT-G) score at 3 months, in those patients randomized for immediate palliative care team consultation while they were in the ED. There was a trend in survival. It would be important to know whether ED initiation of the palliative care chain will result in a decrease in readmission rates and the ethnic/racial and socioeconomic disparity of these services rendered. Future prospective interdisciplinary studies involving the intersection of emergency and/or urgent care, oncology, and palliative care practitioners are necessary to further refine optimal and cost-effective, patient-centered care for patients with cancer and caregivers.

ARTICLE INFORMATION

Conflict of Interest Disclosures: None reported.
Todd  KH, Thomas  CR  Jr, eds. Oncologic Emergency Medicine: Principles and Practice. New York, NY: Springer; 2016.
Lamba  S, Mosenthal  AC.  Hospice and palliative medicine: a novel subspecialty of emergency medicine. J Emerg Med. 2012;43(5):849-853.
PubMed   |  Link to Article
Grudzen  CR, Richardson  LD, Johnson  PN,  et al.  Emergency department–initiated palliative care in advanced cancer: a randomized clinical trial [published online January 14, 2016]. JAMA Oncol. doi:10.1001/jamaoncol.2015.5252.
Kandarian  B, Morrison  RS, Richardson  LD, Ortiz  J, Grudzen  CR.  Emergency department-initiated palliative care for advanced cancer patients: protocol for a pilot randomized controlled trial. Trials. 2014;15:251.
PubMed   |  Link to Article

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