The Surgery for Cancer with Option of Palliative Care Expert (SCOPE) Trial

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Abstract For elderly patients, care at the end of life (EOL) is often fragmented, expensive, needlessly aggressive, and insufficient to provide comfort and dignity. Expert palliative care consultation is one strategy to improve EOL care. Involvement of palliative care providers has also been shown to improve clinical and patient-reported outcomes when initiated early in the course of treatment for life-threatening diseases, especially cancer. However, the utility of early palliative care is not well studied in older adults undergoing surgery for cancer. There is a driving unmet need to improve outcomes of patients undergoing surgery for cancer while improving EOL care for those who ultimately succumb to their disease. Early palliative care consultation is a promising strategy to meet this need. The Surgery for Cancer with Option of Palliative Care Expert (SCOPE) Trial will begin to answer the question of whether patients undergoing surgery for cancer will benefit from early palliative care. SCOPE is a randomized controlled trial enrolling 200 patients undergoing resections for malignancies with particularly poor prognoses. In the intervention arm, patients will receive a pre-operative consultation with a palliative care provider along with continued inpatient and outpatient palliative care follow-up post-operatively. Control arm patients will receive usual care. The Specific Aims of the SCOPE Trial are to determine: 1) whether the intervention improves physical and functional quality of life at 90 days along with other markers of recovery from surgery; 2) whether intervention patients have improved cancer survivorship; and 3) whether the intervention increases the quality of EOL care. The SCOPE Trial forms part of the career development plan of Dr. Myrick Shinall to mature into an independent researcher of the benefit of palliative care interventions for surgical patients with serious age- related conditions. The SCOPE Trial will provide a platform for Dr. Shinall to launch larger, more intensive investigations of palliative care in older surgical populations. While conducting the trial, Dr. Shinall will also undertake training in clinical trial methodology, aging research, biostatistics, patient-centered outcomes research, and grantsmanship. He will additionally benefit from the guidance of his primary mentor, Dr. E. Wesley Ely, who has maintained independent federal funding for 15 years and has mentored several young investigators to independence in the process. The combination of didactic training, Dr. Ely's mentorship, and experience gained from conducting the SCOPE trial will allow Dr. Shinall to develop into an independent investigator of palliative care interventions in surgical patients with serious age-related conditions.