Trial reveals benefits of ‘stepped’ palliative care for patients with advanced lung cancer

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A new study led by investigators from Mass General Cancer Center reveals the effectiveness of more scalable ways of delivering palliative care to patients with advanced lung cancer.

The findings were highlighted at the American Society of Clinical Oncology’s annual meeting and are published in JAMA in a paper titled “Stepped Palliative Care for Patients with Advanced Lung Cancer: A Multi-site Randomized Clinical Trial.”

The study, led by Jennifer S. Temel, MD of the Mass General Cancer Center, assessed the effectiveness of stepped palliative care, in which all patients receive palliative care for their condition, but with a minimum of required contact with a specialty-trained clinician. More intensive treatment is reserved for those who do not benefit sufficiently from the less intensive care.

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This randomized trial included 507 patients with advanced lung cancer who received either early standard palliative care or stepped palliative care.

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Studies show that early palliative care, integrated with oncology care from the time of diagnosis of advanced cancer, improves patient and caregiver outcomes. However, this care model has not been widely implemented for two main reasons: the shortage of palliative care clinicians nationwide and challenges in providing palliative care visits throughout the course of cancer treatment, especially as novel therapeutics prolong survival.

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Investigators in this study found that stepped palliative care, with visits occurring only at key points in patients’ cancer trajectories and using a decrease in quality of life to trigger more visits, resulted in fewer palliative care visits without diminishing the benefits for patients’ quality of life.

“To our knowledge, this is the first randomized trial to establish the non-inferiority of a palliative care strategy that’s tailored to a patient’s needs by triggering more intensive palliative care services based on patient-reported quality of life, compared with resource-intensive early palliative care,” said Temel, who co-directs the Cancer Outcomes Research and Education Program and is the clinical director of Thoracic Oncology at Massachusetts General Hospital.