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Impact of a Systematic Palliative Care on Quality of Life, in Advanced Idiopathic Pulmonary Fibrosis. (PALIF)

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ClinicalTrials.gov Identifier: NCT03229343
Recruitment Status : Recruiting
First Posted : July 25, 2017
Last Update Posted : January 26, 2018
Sponsor:
Information provided by (Responsible Party):
Assistance Publique - Hôpitaux de Paris

Brief Summary:

Idiopathic pulmonary fibrosis (IPF) is a rare and severe disease with a survival median between 2 and 4 years which leads to a profound alteration of the quality of life.

In thoracic oncology, the systematic and early intervention of a palliative care team result in an improvement of quality of life for patients.

In the princeps study published in 2010, the early intervention of a dedicated palliative care team was compared to standard care in a randomized trial of 150 patients and shows a significant improvement : (i) of quality of life (main objective), (ii) of depression scores and even overall survival (11.6 months vs. 8.9 months, P = 0.02), (iii) a benefit in terms of understanding the diagnosis and therapeutic goals (3), (iv) diminution of adapted hospitalization in end of life (in emergency or not).

Considering some analogy points between IPF and advanced lung cancer (prognosis, respiratory symptom, psychological burden), it seemed reasonable to assume that the joint systematic intervention of chest physician and palliative care team may provide a significant benefit in terms of quality of life for patients with severe IPF.


Condition or disease Intervention/treatment Phase
Idiopathic Pulmonary Fibrosis Other: Supportive care Not Applicable

Detailed Description:

Idiopathic pulmonary fibrosis (IPF) is a rare and severe disease with a survival median between 2 and 4 years which leads to a profound alteration of the quality of life. This alteration results from different consequences of the IPF: progressive shortness of breath, irritative cough refractory to treatments, exhaustion, limitation of activity, social isolation, and psychic consequences such as fear, anxiety and depression.

The only current curative treatment of the disease is pulmonary transplantation, but it's only feasible for a minority of patients. Anti-fibrotic drugs, such as pirfenidone and nintedanib, are likely to slow the progression of IPF but have no impact on patients' quality of life.

The symptomatic treatment aimed at relieving respiratory discomfort and the patient's quality of life is therefore fundamental, and the IPF meets in many ways the challenges of lung cancer.

In thoracic oncology, the systematic and early intervention of a palliative care team result in an improvement of quality of life for patients.

In the princeps study published in 2010, the early intervention of a dedicated palliative care team was compared to standard care in a randomized trial of 150 patients and shows a significant improvement : (i) of quality of life (main objective), (ii) of depression scores and even overall survival (11.6 months vs. 8.9 months, P = 0.02), (iii) a benefit in terms of understanding the diagnosis and therapeutic goals (3), (iv) diminution of adapted hospitalization in end of life (in emergency or not).

Considering some analogy points between IPF and advanced lung cancer (prognosis, respiratory symptom, psychological burden), it seemed reasonable to assume that the joint systematic intervention of chest physician and palliative care team may provide a significant benefit in terms of quality of life for patients with severe IPF.

Objective:

To investigate the benefit on quality of life, evaluated after 6 months, of a systematic, formalized and joint intervention of a palliative intervention staff and a chest physician team compared to standard care for patients with severe IPF.

Secondary endpoints

  1. To evaluate the benefit of the systematic, formalized and joint intervention of a palliative care team and a chest physician team on:

    • Mood and depression
    • Understanding of diagnosis and therapeutic objectives, frequency of drafting of advance directives regarding end-of-life
    • Respiratory symptoms (cough and dyspnea)
    • The course of care, the use of palliative care stays and the duration of hospital stays (number and duration of hospitalizations).
    • Overall survival and place of death.
  2. Carry out a medico-economic study evaluating the incremental cost-utility and cost-effectiveness ratio (overall survival criterion)

Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 120 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Intervention Model Description:

Experimental arm : supportive care, systematic and joint to pneumological consultation, monthly, starting at M0 and continuing up to M6.

Non interventionnel arm: only pneumological consultation performed at M0, M3 and M6.

Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: Impact of a Systematic Palliative Care on Quality of Life, in Advanced Idiopathic Pulmonary Fibrosis (IPF). A Randomized Multi-center Trial.
Actual Study Start Date : December 4, 2017
Estimated Primary Completion Date : February 2020
Estimated Study Completion Date : February 2021


Arm Intervention/treatment
Experimental: Experimental
Supportive care, systematic and joint to pneumological consultation, monthly, starting at M0 and continuing up to M6.
Other: Supportive care
supportive care, systematic and joint to pneumological consultation, monthly, starting at M0 and continuing up to M6.

No Intervention: standard
pneumological consultation performed at M0, M3 and M6



Primary Outcome Measures :
  1. The benefit of a systematic, formalized and joint intervention of a palliative intervention staff and a chest physician team on quality of life, evaluated after 6 months by the Short Form (36) Health Survey. [ Time Frame: at 6 months after inclusion ]
    The Short Form (36) Health Survey is a 36-item, patient-reported survey of patient health. The Short Form (36) Health Survey consists of eight scaled scores, which are the weighted sums of the questions in their section. Each scale is directly transformed into a 0-100 scale on the assumption that each question carries equal weight. The lower the score the more disability. The higher the score the less disability i.e., a score of zero is equivalent to maximum disability and a score of 100 is equivalent to no disability. The eight sections are: vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, mental health. This score has already been used for IPF


Secondary Outcome Measures :
  1. The benefit of the systematic, formalized and joint intervention of a supportive care and a pneumologist team on the benefit of the systematic, formalized and joint intervention of a supportive care and a pneumologist team on Mood and depression [ Time Frame: at 3 and 6 months after inclusion ]

    evaluated by the Hospital Anxiety and Depression questionnaire.

    • Understanding of diagnosis and therapeutic objectives, frequency of drafting of advance directives
    • Respiratory symptoms (dyspnea)
    • The course of care, the use of palliative care stays and the duration of hospital stays (number and duration of hospitalizations).
    • Overall survival and place of death.

  2. The benefit of the systematic, formalized and joint intervention of a supportive care and a pneumologist team on Understanding of diagnosis and therapeutic objectives, frequency of drafting of advance directives. [ Time Frame: at 3 and 6 months after inclusion ]
    the benefit of the systematic, formalized and joint intervention of a supportive care and a pneumologist team on Understanding of diagnosis and therapeutic objectives, frequency of drafting of advance directives will be evaluated by the illness understanding questionnaire.

  3. The benefit of the systematic, formalized and joint intervention of a supportive care and a pneumologist team on Respiratory symptoms (dyspnea) [ Time Frame: at 3 and 6 months after inclusion ]
    The benefit of the systematic, formalized and joint intervention of a supportive care and a pneumologist team on Respiratory symptoms (dyspnea) will be evaluated by St George's respiratory questionnaire (SGRQ) and Transition Dyspnea Index (TDI)

  4. The benefit of the systematic, formalized and joint intervention of a supportive care and a pneumologist team on the course of care. [ Time Frame: at 3 and 6 months after inclusion ]
    the benefit of the systematic, formalized and joint intervention of a supportive care and a pneumologist team on the course of care, the use of palliative care stays and the duration of hospital stays (number and duration of hospitalizations)

  5. The benefit of the systematic, formalized and joint intervention of a supportive care and a pneumologist team on the Overall survival. [ Time Frame: between inclusion and date of death or last news. (survival follow-up visit at month 12) ]
    the benefit of the systematic, formalized and joint intervention of a supportive care and a pneumologist team on the Overall survival measured between inclusion and date of death or last news.

  6. Carry out a medico-economic study evaluating the incremental cost-utility and cost-effectiveness ratio (overall survival criterion) [ Time Frame: at 3 and 6 months after inclusion ]
    This outcome is evaluated by the medico-economic questionnaire : EuroQol five dimensions questionnaire (EQ-5D)



Information from the National Library of Medicine

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Ages Eligible for Study:   41 Years and older   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Age> 40 years
  • Patient with confirmed diagnosis of IPF according to the American Thoracic Society (ATS) / European Respiratory Society (ERS) / Japanese Respiratory Society (JRS) / Latin American Thoracic Association (ALAT) criteria. The patient may be included regardless of the date of diagnosis.
  • Advanced IPF with Forced Vital Capacity (FVC) <50%" of predicted value and / or Diffusing capacity for carbon monoxide ((DLCO) <30% of predicted value or inability to achieve the Functional Respiratory Investigations (EFR) due to respiratory severity. EFR dated less than 3 months.
  • Absence of argument for acute or subacute exacerbation in the last 6 months.
  • Patient who can be followed in ambulatory consultation/ outpatient consultation.
  • Informed consent signed (signed by the patient or in the presence of a third party for patients who are poorly fluent in French).
  • Affiliation to the social security system.

Exclusion Criteria:

  • Patient unable to respond to quality of life questionnaires.
  • Inability (physical or mental) to give a written informed consent.
  • Acute exacerbation of fibrosis in the previous 6 months.
  • Patient eligible for a pulmonary transplant.
  • Participation in other therapeutic trial
  • Patient cannot be followed in ambulatory consultation.
  • Patient under trustee

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03229343


Contacts
Contact: Boris Duchemann, Dr 01 48 95 50 32 boris.duchemann@aphp.fr
Contact: Nacira DARGHAL, PhD 01 48 95 74 73 nacira.darghal@aphp.fr

Locations
France
Centre Hospitalier Robert Ballanger Not yet recruiting
Aulnay-sous-Bois, France, 93602
Contact: Jérome VIRALLY, Pr         
Hôpital Avicenne Recruiting
Bobigny, France, 93000
Contact: Boris DUCHEMANN, PI         
Centre Hospitalier de Versailles Andre Mignot Not yet recruiting
Le Chesnay, France, 78150
Contact: Nathalie MICHENOT, Dr         
Hôpital LOUIS PRADEL Recruiting
Lyon, France, 69677
Contact: Vicent COTTIN, Pr         
Hôpital NORD Not yet recruiting
Marseille, France, 13015
Contact: Martine REYNAUD GAUBERT, Pr         
Hôpital MARC JACQUET Recruiting
Melun, France
Contact: Djamel BENNEGADI, Dr         
Hôpital GEORGES POMPIDOU (HEGP) Not yet recruiting
Paris, France, 75015
Contact: Dominique ISRAEL-BIET, Pr         
Hôpital Tenon Not yet recruiting
Paris, France, 75020
Contact: Jean Marc NACCACHE, Pr         
Hôpital Pontchaillou Recruiting
Rennes, France, 35033
Contact: Stéphane JOUNEAU, Pr         
Hôpital DELAFONTAINE Not yet recruiting
Saint-Denis, France, 93200
Contact: Isabelle LERAT, Dr         
Hôpital LARREY Not yet recruiting
Toulouse, France, 31059
Contact: Grégoire PREVOT, Dr         
Sponsors and Collaborators
Assistance Publique - Hôpitaux de Paris
Investigators
Principal Investigator: Boris Duchemann Assistance Publique - Hôpitaux de Paris

Publications:
Responsible Party: Assistance Publique - Hôpitaux de Paris
ClinicalTrials.gov Identifier: NCT03229343     History of Changes
Other Study ID Numbers: P150965
First Posted: July 25, 2017    Key Record Dates
Last Update Posted: January 26, 2018
Last Verified: July 2017
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Keywords provided by Assistance Publique - Hôpitaux de Paris:
idiopathic pulmonary fibrosis, palliative care

Additional relevant MeSH terms:
Fibrosis
Pulmonary Fibrosis
Idiopathic Pulmonary Fibrosis
Idiopathic Interstitial Pneumonias
Pathologic Processes
Lung Diseases
Respiratory Tract Diseases
Lung Diseases, Interstitial