Neoplasms

Skin and Connective Tissue Diseases

All Conditions

Symptoms and General Pathology

Breast Neoplasms

Death

Breast Diseases

Skin Diseases

After the screening procedure confirm eligibility to participate in the research study. Participants will be randomized into one of two study groups;

-- Standard oncology care with palliative care.

After the screening procedure confirm eligibility to participate in the research study. Participants will be randomized into one of two study groups;

-- Standard oncology care

Patients randomized to the intervention will receive collaborative care from palliative care and oncology for the remainder of their illness. The initial five visits with palliative care will be conducted in accordance with the study specific clinical practice guidelines and occur at least monthly.

Palliative and Oncology Care

Patients randomized to oncology care alone will continue to receive routine care identical to what they would have received if they had not participated in the trial. Either patients or their oncologists can request palliative care consultation at any point in time.

Standard Oncology Care

Jennifer Temel, MD

The purpose of this research study is to test a new way to deliver oncology and palliative care for patients with metastatic breast cancer.

* The goal of this study is to test a model where oncology and palliative care work together to care for participants with metastatic breast cancer who were recently admitted to the hospital or have new or worsening cancer involving their brain or the fluid around the brain or spinal cord.
* The investigators are studying whether participants who receive care from both teams have better communication about their care and improved quality of life and mood compared to those receiving care from only their oncologists.

The purpose of this randomized clinical trial is to conduct a randomized trial testing the impact of the collaborative palliative and oncology care model or standard oncology care models among patients with poor prognosis metastatic breast cancer. Participants assigned to the intervention arm will participate in a series of structured palliative care visits, following tailored clinical practice guidelines previously developed for patients with metastatic breast cancer.

This research study tests whether or not the earlier introduction of a team of clinicians that specialize in the lessening (palliation) of symptoms and addressing quality of life concerns may improve the end-of-life care, quality of life, and mood of women with poor prognosis metastatic breast cancer.

Palliative care is a specific type of medical care given to patients to improve their pain and other symptoms like fatigue, and to support patients and their families as they cope with their illness. Palliative care includes physicians and advanced practice nurses who have been specifically trained in how to help patients with serious illness.

Increasingly, the role of palliative care has been shown to benefit patients when introduced early in the disease trajectory. For example, in patients with metastatic (or spread) lung cancer, early involvement of palliative care improves patients' quality of life and mood. Patients with some metastatic cancers, like breast cancer, have an unpredictable disease trajectory, which makes it difficult to determine the best time to introduce palliative care services.

Palliative And Oncology Care Model In Breast Cancer

A Collaborative Palliative and Oncology Care Model for Metastatic Breast Cancer

Compare differences in rate of documentation of end of life care preferences (Yes documented vs. No)

Examine patient report of end of life care preferences with their clinician using the following item: "have you and your doctors discussed any particular wishes you have about the care you want to receive if you were dying?" Although patients complete this measure repeatedly during the course of the study, the investigators will use the final assessment either prior to death or at six months follow-up (whichever comes first) for this analysis.

Compare patient-reported quality of life between the two study arms at weeks 6, 12, 18, and 24.

Compare patient-reported depression symptoms between the two study arms at weeks 6, 12, 18, and 24.

Compare patient-reported anxiety symptoms between the two study arms at weeks 6, 12, 18, and 24.

Examine differences in rates of chemotherapy administration during the last 3, 7, and 14 days of life between the two study arms

Examine difference the in rates of hospice utilization between the two study arms.

Examine difference in hospice length-of-stay between the two study arms.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Palliative And Oncology Care Model In Breast Cancer	NCT02730858	Metastatic Brea...	Palliative and ... Standard Oncolo...	18 Years -	Massachusetts General Hospital
Palliative And Oncology Care Model In Breast Cancer	NCT02730858	Metastatic Brea...	Palliative and ... Standard Oncolo...	18 Years -	Massachusetts General Hospital

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