Proactive symptom monitoring to initiate timely palliative care for patients with advanced cancer: a randomized controlled trial

Purpose: To deliver timely palliative care in response to supportive and palliative care needs as they arise, we developed a model called “Supportive and Palliative care Review Kit in Locations Everywhere” (SPARKLE), which comprises regular remote symptom monitoring using the Integrated Palliative care Outcome Scale (IPOS); early identification and prompt treatment of palliative care symptoms and concerns identified; and referral to specialist palliative care if follow-up is required. Methods: A prospective randomized controlled trial of SPARKLE versus usual care was conducted among patients with advanced cancers. The primary endpoint was Functional Assessment of Cancer Therapy-General (FACT-G) scores at 16 weeks post randomization. Results: A total of 239 patients were randomized—119 patients to usual care and 120 patients to SPARKLE intervention. There was no significant difference in total FACT-G score (baseline-adjusted difference 0.8, 95% CI − 3.5 to 5.1, p = 0.73). Physical well-being was better in the SPARKLE intervention group compared to the usual care group (baseline-adjusted difference 1.9, 95%CI 0.4 to 3.4, p = 0.01). There were no significant differences in the other domain scores. There were no differences in palliative care referrals, occurrence of emergency department visits, or hospital admissions. Conclusion: Although there was no significant difference in overall quality of life, better physical symptom control could have been achieved through proactive identification and treatment of symptoms and concerns by the SPARKLE nurse. Further studies are warranted to evaluate how various components of palliative care service models impact clinical outcomes. Trial registration: ClinicalTrials.gov identifier: NCT04242251. Date of registration: 23 January 2020.