Virtual and In-Person Palliative Care Equally Beneficial in Advanced Lung Cancer

CHICAGO — Early palliative care delivered via video was as effective as in-person visits on quality-of-life (QoL) measures among patients with advanced lung cancer, according to the REACH-PC trial.

Further, patient and caregiver-reported satisfaction with care and patient-reported anxiety and depression symptoms did not differ between study groups randomized to video visits or in-person visits for their palliative care.

“The main takeaway is that palliative care led to equivalent benefits for patient-reported quality of life whether delivered either via video or in-person visits among adults with advanced lung cancer.,” said Joseph A. Greer, PhD, of Massachusetts General Hospital and Harvard Medical School in Boston.

“The study findings underscore the potential to increase access to evidence-based early palliative care through telehealth delivery,” Greer said during a press briefing at the American Society of Clinical Oncology (ASCO) annual meeting.

To assess QoL, trial patients completed the Adjusted Mean Functional Assessment of Cancer Therapy-Lung (FACT-L), with higher scores indicating better QoL. The equivalence margin was an estimated difference in score on the FACT-L between groups of ±4 points. The observed adjusted FACT-L scores at 24 weeks were 99.7 in the video-visit group versus 97.7 in the in-person group, thereby meeting the criterion for equivalence (P=0.04).

About 41% of patients and 37% of caregivers in each study group reported satisfaction with care. Patient anxiety and depression scores were similar between the video-visit and in-person groups as well.

Caregiver attendance was greater in the in-person arm of the study, with 49.7% complying with the in-person visits, compared with 36.6% who attended the video visits (P

The study proved that broad dissemination of palliative care to patients who otherwise may not be able to receive it is possible, commented Charu Agarwal, MD, MPH, at the University of Pennsylvania in Philadelphia. “We now have the technology to reduce the burden [of palliative care] on patients and use it to our advantage.”

Most patients with metastatic lung cancer experience burdensome physical and psychological symptoms in addition to impaired QoL at some point along the disease course.

National guidelines from ASCO and other professional organizations recommend integrating palliative care from the time of diagnosis of advanced cancer. These guidelines are based on evidence from multiple clinical trials demonstrating the efficacy of early palliative care for improving QoL, mood symptoms, coping, and other key outcomes in the advanced cancer population, said Greer. “Unfortunately, most patients with advanced cancer and their families do not receive this evidence-based care due to multiple barriers, chief among them being the limited availability of specialty trained palliative care clinicians and practical issues in accessing supportive care,” he said.

The use of telehealth has accelerated dramatically since the onset of the COVID-19 pandemic, he noted, and offers a promising solution to helping patients overcome obstacles to obtaining palliative care. The benefits of telehealth have been recognized in improving access to supportive oncology services, “and recent studies have shown the utility of telehealth for reducing healthcare-related costs in patients with cancer,” he said.

Although many healthcare facilities have the capacity to offer video visits, whether the virtual modality is as effective as in-person care in improving patient outcomes was unknown. Hence, Greer and colleagues conducted a comprehensive comparative effectiveness trial to answer this key question.

The primary aim was to evaluate the equivalence of the effect of delivering early palliative care via video versus in-person visits on patient-reported QoL in a sample of 1,250 patients with advanced NSCLC and 548 of their caregivers.

Patients and caregivers were enrolled from June 2018 through May 2023, during which time they were randomly assigned to monthly video visits or in-person early palliative care. Twenty-two U.S. cancer centers participated. Participants completed QoL measures of satisfaction and mood symptoms every 12 weeks until week 48 postrandomization.

Palliative visits most often include identification and management of symptoms (i.e., fatigue, pain, dyspnea) either by the palliative care team or another specialist via referral from the palliative care team, psychological support, and coping skills, said Greer, and the content of these visits is remarkably similar whether delivered by telehealth or in person.

The average age of participants was approximately 65, slightly more than half were women, and most self identified as white Non-Hispanic and married. The two groups were well balanced with respect to sociodemographic and clinical characteristics.

Ideally, the findings will inform policy decisions regarding the role of coverage of virtual care visits in the future, said Greer. Video visits can reduce the burdens of travel, costs, and risk for infection among potentially immune-compromised or frail patients, he said, but when in-person visits are essential remains to be determined.

Further research is needed to increase representation of patients from diverse backgrounds and to conduct analyses to determine whether intervention effects vary across subgroups.