Palliative care initiated upon diagnosis helped patients with metastatic non-small cell lung cancer (NSCLC) not only have better quality of life (QOL) but also live longer, in a phase III randomized trial comparing early palliative care to standard cancer care. Jennifer S. Temel, MD, of Massachusetts General Hospital, Boston, presented the study at the 2010 ASCO Annual Meeting.¹

"Compared with standard oncology care, integrated palliative care led to improvements in QOL, lower rates of depression, less aggressive care at the end of life, greater documentation of resuscitation preferences, and higher survival rates," Dr. Temel reported.

Study Design

In the study, 150 patients with newly diagnosed metastatic NSCLC were randomly assigned to early palliative care integrated with standard oncology care, which included palliative care visits at least monthly, or to standard care, which included palliative care visits only when requested by the patient, family, or oncologist.

QOL was determined by measuring symptoms and functional/physical well-being according to the Functional Assessment of Cancer Therapy (FACT)-Lung questionnaire (Lung Cancer Symptom Index and Trial Outcome Index), and psychological distress according to the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9 (PHQ-9). Change in the FACT-Lung Trial Outcome Index was the primary endpoint.

At 12 weeks, 100% of the palliative care arm had received at least one palliative care visit, and 65% had four or more visits. In the standard care arm, 4% of patients had two visits, 9% had one visit, and no patient had more than two palliative care visits.

Key Results

Fewer patients randomized to palliative care received aggressive care (33.3% vs 53.6%; P = .05). Nevertheless, they lived significantly longer (11.6 vs 8.9 months; P = .02), Dr. Temel reported.

Aggressive care was defined as no use of hospice, use of hospice for 3 days or less, or chemotherapy administered within 14 days of death. Patients in the standard care arm averaged 4 days of hospice, compared to 11 days for the palliative care arm. Patients in the palliative care arm were more likely to have documented their resuscitation preferences (53% vs 28%; P = .05).

QOL was significantly better for patients in the palliative care arm, as judged by all measures. The mean FACT-Lung score was 98.0 for the palliative care arm vs 91.5 for the standard care arm (P = .03), the mean Lung Cancer Symptom score was 21.0 vs 19.3 (P = .04), and the mean Trial Outcome Index score was 59.0 vs 53.0 (P = .009). Patients receiving palliative care also had lower rates of depression on the HADS (15.8% vs 38.3%; P = .01) and the PHQ-9 (3.5% vs 17%; P = .02). While patients in the palliative care arm improved over baseline in virtually all QOL measures, those receiving standard care declined.

Raffit Hassan, MD, of the National Cancer Institute, noted that this is the first randomized study of early palliative care in patients with newly diagnosed advanced NSCLC. "It shows that palliative care and active cancer therapy can go hand in hand," he said, "and that initiation of palliative care at diagnosis improves quality of life, psychological well-being, end-of-life care, and even survival." ■

Reference

1. Temel JS, Greer J, Gallagher E, et al: Effect of early palliative care (PC) on quality of life (QOL), aggressive care at the end-of-life (EOL), and survival in stage IV NSCLC patients: Results of a phase III randomized trial. 2010 ASCO Annual Meeting. Abstract 7509. Presented June 7, 2010.