How Stepped Palliative Care Can Improve Quality of Life for Lung Cancer Patients

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In a randomized clinical trial, the effectiveness of a stepped-care model for delivering palliative care to patients with advanced lung cancer was evaluated.

A recently released study presented at the American Society of Clinical Oncology (ASCO) 2024 annual meeting and published in Jama Network found that stepped palliative care led to fewer visits and lower utilization of palliative care resources.

The randomized clinical trial evaluated the effectiveness of a stepped-care model for delivering palliative care to patients with advanced lung cancer.

The study compared the outcomes of patients receiving stepped palliative care, with visits occurring only at critical points in their cancer trajectories, to those receiving early palliative care with monthly visits after diagnosis.

Advanced lung cancer is a challenging diagnosis, both for patients and their caregivers. As the disease progresses, symptoms can become more severe, and managing pain and other distressing symptoms becomes a top priority. Palliative care becomes clinically necessary at this stage of patient care.

Palliative care is specialized medical care that focuses on providing relief from the symptoms and stress of a serious illness. A stepped approach to palliative care can be particularly beneficial for patients with advanced lung cancer in managing their symptoms and improving their quality of life.

Stepped palliative care is a model of care that involves providing different levels of support and intervention based on the patient's needs. For patients with advanced lung cancer, this may include starting with basic symptom management techniques, such as pain medication or breathing exercises, and then progressing to more intensive interventions, such as palliative chemotherapy or radiation therapy.

One key benefit of stepped palliative care is that it can be tailored to meet each patient's individual needs. For some patients, controlling pain may be the top priority, while managing shortness of breath or fatigue may be more important for others. By adapting the level of support and intervention to each patient's unique situation, stepped palliative care can help improve their overall well-being and quality of life.

The study's primary outcome measure was patient-reported quality of life (QOL) assessed using the Functional Assessment of Cancer Therapy–Lung scores at week 24. The study found that patients assigned to stepped palliative care had significantly fewer palliative care visits but reported non-inferior QOL scores compared to those assigned to early palliative care. Results indicate that stepped palliative care was effective in improving QOL for patients with advanced lung cancer in a more scalable and patient-centered manner.

The study also explored secondary outcomes, such as the impact on utilization of palliative care and hospice services and other patient-reported outcomes. While the rate of end-of-life care communication was similar between the groups, there was a difference in the number of days in hospice, with fewer days for patients receiving stepped palliative care.

Findings suggest that a stepped-care model for delivering palliative care to patients with advanced lung cancer can be an effective and more scalable approach to improving patient-reported outcomes and QOL. This model allows for tailored care based on patients' clinical needs, with more intensive treatment reserved for those who do not benefit sufficiently from less intensive therapies.

“Tailoring early palliative care to patients’ illness trajectories and care needs is a more patient-centered and scalable way to deliver evidence-based oncology care for patients with advanced cancer. These findings are especially salient as patients with advanced cancer are now living longer while being treated with life-long cancer therapies, so a tailored palliative care model enables greater dissemination of palliative care services while ensuring patients receive the care they need when they need it,” according to the corresponding author and Clinical Director of Thoracic Oncology at Massachusetts General Hospital, Jennifer Temel, M.D.

The study adds to the existing evidence supporting early palliative care for patients with advanced cancer and addresses the challenges posed by limited palliative care resources. Implementing a stepped-care model could potentially enhance access to palliative care and improve outcomes for patients with advanced lung cancer.

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