The findings from a study of “real-world” patients with advanced lung cancer published in JAMA Oncology suggest that implementation of early palliative care was associated with increased survival in patients less seriously ill at diagnosis.
Although results of a landmark clinical trial showed an association between early palliative care and increased survival in patients with metastatic non-small cell lung cancer (NSCLC),2 a meta-analysis of randomized clinical studies of patients with life-limiting illness did not demonstrate an improvement in the survival of adult patients receiving palliative care vs usual care.3 The purpose of this study was to address the potential impact of palliative care on survival in a “real-world” population of patients with advanced lung cancer.
This retrospective population-based cohort study included 23,154 patients from the Veterans Affairs (VA) Central Cancer Registry with stage IIIB or IV lung cancer diagnosed between January 1, 2007, and December 31, 2013.
Selection bias was minimized in this study through a comparison of patients who received palliative care, defined as “a specialist-delivered palliative care encounter received in an inpatient or outpatient setting after a lung cancer diagnosis,” with a cohort of patients matched according to baseline characteristics who did not receive palliative care.
Median patient age was 68 years, 89% of tumors were stage IV, 69% of patients had a diagnosis of NSCLC, and 57% of patients received palliative care.
Interestingly, the use of palliative care increased by 41% between 2007 and 2013.
In the overall patient cohort, use of palliative care vs no palliative care was associated with a significantly decreased risk of dying in an acute care setting (adjusted odds ratio, 0.57; 95% CI, 0.52-0.64; P <.001).
Nevertheless, in the overall patient cohort, use of palliative care was associated with a decrease in patient survival when compared with not receiving palliative care (adjusted hazard ratio [aHR], 1.19; 95% CI, 1.15-1.23; P <.001).