Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer
Authors: Greer Joseph A. , Temel Jennifer S. , El-Jawahri Areej , Rinaldi Simone , Kamdar Mihir , Park Elyse R. , Horick Nora K. , Pintro Kedie , Rabideau Dustin J. , Schwamm Lee , Feliciano Josephine , Chua Isaac , Leventakos Konstantinos , Fischer Stacy M. , Campbell Toby C. , Rabow Michael W. , Zachariah Finly , Hanson Laura C. , Martin Sara F. , Silveira Maria , Shoemaker Laura , Bakitas Marie , Bauman Jessica , Spoozak Lori , Grey Carl , Blackhall Leslie , Curseen Kimberly , O’Mahony Sean , Smith Melanie M. , Rhodes Ramona , Cullinan Amelia , Jackson Vicki ,   REACH PC Investigators, Trotter Chardria , Gallagher Medeiros Emily , Calton Brooke A. , Carlson Heather A. , Cartagena Leslie , Diop Michelle , Evans Theresa , Jackson James G. , O’Brien Karen , Petrillo Laura A. , Shin Jennifer S. , Browner Ilene , Gray Nathaniel , Awad Mark , Tulsky James , Christensen Kelly J. , Rhee Laura S. , Strand Jacob , Gilhuly Devin , Rondinelli Nicole , Seibert Jennifer , Treem Jonathan , Schueller Kate , Allen Gregory , Blakely Collin , Gubens Matthew , Lindenfeld Paul , Mulvey Claire , Young Natalie , Dale William , Luna Joanna , Mecusker Eric , Moreno Jeanine , Ramirez Carey , Williams Sari , Gaffney Sean , Kelly Cynthia , Lavin Kyle , Iams Wade , Robbins Samuel G. , Kalemkerian Greg , Lagman Ruth , Neale Kyle , Patel Chirag , Samala Renato , Weinstein Elizabeth , McCammon Susan , Taylor Richard , Tucker Rodney , Chwistek Marcin , Collins Molly , Edelman Martin , Judd Julia , Kinczewski Leigh , Murphy Kathleen , Sherry Dylan , Welsh Marie , Sinclair Christian , Wulff-Burchfield Elizabeth , Gabbard Jennifer , Statler Tiffany , Timmins Nathaniel , Kavalieratos Dio , Lowers Jane , Quest Tammie , Chen Elaine , LaBellarte Giulia , Mohinda Nisha , Munger Natalie K. , Munroe Michelle , Patel Jyoti D. , Szmuilowicz Eytan , Vermylen Julia H. , Siropaides Caitlin H. , Ahern Christopher G. , Kobin Emily G. , Vergo Maxwell T. , Wilson Matthew M. 
Published: September 2024

Importance

Numerous studies show that early palliative care improves quality of life and other key outcomes in patients with advanced cancer and their caregivers, although most lack access to this evidence-based model of care.

Objective

To evaluate whether delivering early palliative care via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non–small cell lung cancer (NSCLC).

Design, Setting, and Participants

Randomized, multisite, comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 US cancer centers among 1250 patients within 12 weeks of diagnosis of advanced NSCLC and 548 caregivers.

Intervention

Participants were randomized to meet with a specialty-trained palliative care clinician every 4 weeks either via video visit or in person in the outpatient clinic from the time of enrollment and throughout the course of disease. The video visit group had an initial in-person visit to establish rapport, followed by subsequent virtual visits.

Main Outcomes and Measures

Equivalence of the effect of video visit vs in-person early palliative care on quality of life at week 24 per the Functional Assessment of Cancer Therapy-Lung questionnaire (equivalence margin of ±4 points; score range: 0-136, with higher scores indicating better quality of life). Participants completed study questionnaires at enrollment and at weeks 12, 24, 36, and 48.

Results

By 24 weeks, participants (mean age, 65.5 years; 54.0% women; 82.7% White) had a mean of 4.7 (video) and 4.9 (in-person) early palliative care encounters. Patient-reported quality-of-life scores were equivalent between groups (video mean, 99.7 vs in-person mean, 97.7; difference, 2.0 [90% CI, 0.1-3.9]; P = .04 for equivalence). Rate of caregiver participation in visits was lower for video vs in-person early palliative care (36.6% vs 49.7%; P &amp;lt; .001). Study groups did not differ in caregiver quality of life, patient coping, or patient and caregiver satisfaction with care, mood symptoms, or prognostic perceptions.

Conclusions and Relevance

The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC, underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery.

Trial Registration

ClinicalTrials.gov Identifier: NCT03375489