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Clinical Trial
. 2018 Jan 23;8(1):e015904.
doi: 10.1136/bmjopen-2017-015904.

Impact of early palliative care on overall survival of patients with metastatic upper gastrointestinal cancers treated with first-line chemotherapy: a randomised phase III trial

Emilie Hutt  1 , Arlette Da Silva  2 , Emilie Bogart  3 , Sara Le Lay-Diomande  4 , Diane Pannier  1 , Stéphanie Delaine-Clisant  4 , Marie-Cécile Le Deley  3   5 , Antoine Adenis  1   6
Affiliations
Clinical Trial

Impact of early palliative care on overall survival of patients with metastatic upper gastrointestinal cancers treated with first-line chemotherapy: a randomised phase III trial

Emilie Hutt et al. BMJ Open. .

Erratum in

Abstract

Introduction: Palliative care (PC) has usually been offered at the end-of-life stage, although the WHO recommends providing PC as early as possible in the course of the disease. A recent study has shown that early PC (EPC) provides a more meaningful effect on quality of life and, surprisingly, on overall survival (OS) than standard treatment for patients with metastatic lung cancer. Whether EPC benefits also apply to patients with metastatic upper gastrointestinal (GI) cancers is unknown.

Methods and analysis: EPIC is a randomised phase III trial comparing EPC plus standard oncologic care versus standard oncologic care in patients with metastatic upper GI cancers. Its primary objective is to evaluate the efficacy of EPC in terms of OS. Its secondary objectives are to assess the effects of EPC on patient-reported outcomes (quality of life, depression and anxiety) and the effect of EPC on the number of patients receiving chemotherapy in their last 30 days of life. Assuming an exponential distribution of survival time, 381 deaths are required to ensure an 80% power for an absolute difference of 10% in 1 year OS rates (40% vs 50.3%, HR=0.75; log rank test two-sided alpha=5%), leading to a planned sample size of 480 patients enrolled over 3 years and a final analysis at 4 years. The main analysis will be performed on the intent-to-treat dataset.

Ethics and dissemination: This study was approved by the 'Comité de Protection des Personnes Nord-Ouest I' (4 April 2016), complies with the Helsinki declaration and French laws and regulations and follows the International Conference on Harmonisation E6 (R1) Guideline for Good Clinical Practice. The trial results, even if they are inconclusive, will be presented at international oncology congresses and published in peer-reviewed journals.

Trial registration numbers: EudraCT: 2015-A01943-46; Pre-results. NCT02853474.

Keywords: gastrointestinal cancer; palliative care; randomized trial.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Study design.
See this image and copyright information in PMC

References

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    1. Loi n°99-447 Du 9 juin 1999 visant à garantir le droit à l’accès aux soins palliatifs. JORF n° 132 du 10 juin 1999.
    1. Temel JS, Greer JA, Muzikansky A, et al. . Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med 2010;363:733–42. 10.1056/NEJMoa1000678 - DOI - PubMed

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