Whether Telehealth or In Person, Palliative Care Offer Benefits for Patients With Advanced Lung Cancer

Early integration of palliative care with oncology care is recommended for advanced cancer patients, but access is limited. One of the late-breaking abstracts at this year’s ASCO Annual Meeting compared telehealth vs in-person palliative care for patients with advanced non-small cell lung cancer. Telehealth delivery of palliative care was equivalent to in-person care in improving quality of life for patients. There were no differences in patient-reported outcomes like depression, anxiety, or coping skills. However, caregiver participation was lower in the telehealth group. These findings suggest telehealth has potential to improve access to palliative care.

Here, Joseph Greer, PhD, codirector of the Cancer Outcomes Research & Education Program and an associate professor of psychology at Massachusetts General Hospital, and presenter of the abstract, discussed the rationale and findings of the study.

Transcription:

0:05 | So given these unmet needs, ASCO has put forth guidelines to integrate palliative care from the time of diagnosis of advanced cancer, to really support patient coping and improve their quality of life in which patients would meet with a palliative care clinician in tandem with their oncology care over their course of illness in that care that palliative care is really dedicated to improving the care experience and the quality of life of patients with advanced cancer and their loved ones. We have been testing the integration of palliative care now for almost two decades and various efficacy trials have shown that when palliative care does meet with the patient, along with oncology care, it improves patient’s quality of life and improves their mood symptoms, their coping skills, as well as the quality of their care. Unfortunately, most patients do not receive this evidence based care per ASCO guidelines, because of the one major obstacle being the limited availability of trained specialty palliative care clinicians, in addition to just practical barriers of seeking additional care. And so when we were conceiving of this study, we were trying to think of different ways to improve access to palliative care, particularly for people who may be more frail or live in rural areas. And at the time, this was before the pandemic, we were thinking about the use of telemedicine as one way to improve access. And so the goal of this study, which is funded by the patient centered outcomes research institute, was to evaluate whether delivering early integrated palliative care this evidence based model that we’ve been studying for the last couple of decades was equivalent to the delivery of in person of the in person modality of early palliative care versus a video based early palliative care. So essentially, we wanted to enroll participants in randomly assign them to meet with a palliative care clinician from the time of diagnosis, with the same frequency having similar conversations with the only difference being whether they would receive that care in person in clinic or over video. For that we enrolled 1250 patients with advanced non small cell lung cancer. They could also identify caregiver most often a family member to participate. They completed self report measures of quality of life, their mood symptoms, coping perceptions of prognosis and satisfaction with care upon randomization. And then they completed those measures again at 1224 36 and 48 weeks, if they did elect to have a caregiver involved if the caregiver would also complete self remark self report measures that are very similar, and then we followed them over the course of their illness. And we were pleased to find that patients in the video visit group reported equivalent quality of life scores on our primary outcome measure as the in person scores and so is the group as the patients who received in person palliative care, thereby really confirming our primary hypothesis that these two modalities for delivering early palliative care were equivalent. We also found that in terms of the other outcome measures like satisfaction with care or patient or caregiver mood symptoms also did not differ between study groups. So whether patients receive this care either in the video modality or the in person mode Dally, we found that their reported outcomes were quite similar across a range of measures, which was exciting.