ONCORDANCE: Effectiveness of A Care Coach-led Integrated Palliative Surgical Oncology and Rehabilitation Care Model in Patients with Advanced Cancer Undergoing Major Surgery: A Randomized Controlled Trial
The study proposes an integrated Palliative Surgical Oncology and Rehabilitation (PSO+R) care model for advanced cancer patients undergoing major surgery in Singapore, addressing the unmet needs of palliative care and functional rehabilitation in this population. It is a 3-arm randomised controlled trial at SGH and NCCS, with patients allocated to 3 arms: usual care, PSO only, or PSO+R, with the primary outcome such as health-related quality of life (FACT-G) at 6 months post-surgery, alongside palliative care delivery rates and cost-effectiveness at 1 year.
The PSO model trains surgical oncologists in basic palliative care and embeds care coaches within surgical teams to deliver serious illness conversations, advanced care planning, and symptom management longitudinally. The serious illness conversations will focus on the exploration of hopes, worries, critical functions, social set-up and the healthcare proxy identification with the patient. The care coach will also screen for psychological and emotional distress utilising the Distress Thermometer and the Problem List screening tools to provide palliative interventions if deemed necessary. The interventions could range from symptom management to psychosocial support.
The PSO+R arm will have coaches training in palliative care, supported by specialist palliative care (SPC) physicians who will provide palliative care and rehabilitation as the cancer rehabilitation team. Cancer rehabilitation will address functional impairments during the cancer journey, aiming for the maintenance of function and improvement of quality of life. The integration of palliative surgical oncology (PSO) and rehabilitation (+R) addresses both palliative care needs in advanced cancer and functional decline that can arise due to physiological stressors from major surgery and its morbidities.
Principal Investigator
Dr. Wong Si Min Jolene
Clinical Assistant Professor, Duke-NUS Medical School
Consultant, Singapore General Hospital & National Cancer Centre Singapore