Camilla Zimmermann, MD, PhD, FRCPC

Senior Scientist, Princess Margaret Cancer Centre
https://orcid.org/0000-0003-4889-0244
Keywords: palliative care, supportive care, health services research, clinical trials, complex intervention design, mixed methods research

Our research team is studying theoretical, empirical, and methodological aspects of measuring the effectiveness of specialized palliative care. This involves developing and testing potential models for the provision of palliative care, as well as validating existing measures of palliative care effectiveness and creating new ones. A particular focus is the early involvement of palliative care services in the outpatient setting. Funded by the Canadian Institutes of Health Research (CIHR), we have conducted trials of Symptom screening with Targeted Early Palliative care (STEP), versus usual care, in patients with advanced cancer and are planning a further trial of virtual STEP. Additionally, we are conducting a CIHR-funded multicentre mixed methods study using ICES data and qualitative interviews to examine the impact of COVID-19 on cancer care at the end of life. Funded by the Canadian Cancer Society and CIHR, we are also conducting a multicentre randomised trial of a joint psychological and physical symptom intervention to improve patient well-being and symptom control in patients with acute leukemia.

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Associated Program(s)

Early palliative care for patients with advanced cancer: a cluster-randomized controlled trial

Study Status: Completed
Study Purpose: This was a randomized controlled trial to determine whether receiving early outpatient palliative care alongside usual care would improve quality of life, symptom control, and care satisfaction in patients with advanced cancer compared to usual cancer care.
Background: Patients with advanced cancer often have a long period of disability with symptoms such as pain and fatigue, emotional distress, and overall worsening quality of life. Palliative care teams are experts in pain and symptom management and focus on improving quality of life for patients with serious illness and their families. However, referral to palliative care teams for most patients occurs in the last 2 months of life or not at all. We thought that if patients received palliative care earlier, in the outpatient setting, that this might improve their quality of life.
Study Methods: Patients were recruited from 24 clinics at the Princess Margaret Cancer Centre; 12 clinics were randomized to the usual cancer care group and 12 to the early palliative care group. Patients attending these 24 clinics who consented to participate completed surveys of quality of life, symptom control, mood, satisfaction with care, and medical interactions at the start of the study and monthly for 4 months. Participants in the clinics randomized to the “early palliative care” group received a consultation and follow up visits in the outpatient palliative care clinic at the Princess Margaret. The “usual care” group just received the care they would normally receive.
Key Findings: A total of 461 patients and 182 caregivers were recruited from Dec 2006-Feb 2011. 228 patients were in the early palliative care group and 233 were in the usual care group. Results at the end of the study showed that patients who received early palliative care had improved quality of life, symptom control, and satisfaction with care. Satisfaction with care was also improved for caregivers in the early palliative care group. This study has been used in treatment guidelines for advanced cancer. The early involvement of palliative care teams for patients with cancer is now recommended by major international cancer organizations as standard care.
Health Conditions: Cancer,Palliative Care

 

Pilot trial of virtual and in-person Symptom screening with Targeted Early Palliative care (STEP2)

Study Status: Active
Study Purpose: The purpose of this study is to determine if our virtual and in-person “Symptom screening with Targeted Early Palliative care” (STEP2) intervention is practical, and how a larger study should be planned.
Background: Palliative care teams are experts in pain and symptom care and focus on improving quality of life for patients with serious illness and their families. However, due to limited resources, most patients do not have early access to outpatient palliative care alongside their usual cancer care. Our team has developed a new way to identify patients with the greatest need for early palliative care (i.e. those with higher symptom scores). This system is called STEP (Symptom screening with Targeted Early Palliative care). The system uses electronic information patients report about their symptoms before each oncology clinic visit.
Study Methods: Study participants include adult patients with advanced cancer who attend medical oncology clinics at the Princess Margaret Cancer Centre and who have not yet been referred to a palliative care team. Patients who consent to participate will complete questionnaires about their quality of life, symptom control, mood, satisfaction with care, anxiety, and general health status. Questionnaires are completed at the start of the study and after 2, 4 and 6 months. Patients are asked to complete a short questionnaire about their symptoms online up to 48 hours ahead of their oncology visits. Patients who report moderate to high symptom scores at any time during the 6 months are enrolled in the study. The online tool emails the study team automatically. A study nurse will then call these patients to discuss their symptoms and offer a referral for an in-person or virtual visit to the outpatient palliative care clinic at the Princess Margaret. The outpatient palliative care team can help with pain and symptom management, coping and support, arranging care in the home as needed, and planning for the future, alongside their usual cancer care. Those who agree to this referral are offered at least monthly in-person and/or virtual palliative care clinic follow-up visits. This continues until the study ends and is based on patient needs and care provider preference. Additionally, all participants will be offered a chance to participate in a one-time one-on-one study interview with a study staff member during the study. These interviews will explore factors patients considered (or would consider) when deciding to accept or defer the outpatient palliative care clinic referral.
Health Conditions: Cancer,Palliative Care

 

For a list of Dr. Zimmermann's publications, please visit PubMed, Scopus or ORCID.

Senior Scientist, Princess Margaret Cancer Centre

Head, Department of Supportive Care, Princess Margaret Cancer Centre
Head, Division of Palliative Care, University Health Network
Harold and Shirley Lederman Chair in Palliative Care and Psychosocial Oncology
Professor of Medicine, University of Toronto