According to a new retrospective, population-based cohort study, early palliative care could have a survival benefit in patients with advanced lung cancer.
“Palliative care is a patient-centered approach associated with improvements in quality of life; however, results regarding its association with a survival benefit have been mixed, which may be a factor in its underuse,” wrote the study authors, whose findings were published in JAMA Oncology.
The study included patients who received a lung cancer diagnosis between Jan. 1, 2007, and Dec. 31, 2013; follow-up continued through Jan. 23, 2017. Patients with advanced lung cancer (stage IIIB and stage IV) were identified from the Veterans Affairs health care system; data were evaluated from Feb. 15, 2019, through April 28, 2019. Palliative care was defined as “a specialist-delivered palliative care encounter received after lung cancer diagnosis.” The primary outcome was survival, and the correlation between palliative care and place of death was also considered.
Final analysis included 23,154 patients (mean age [SD], 68 [9.5] years; 98% were male) with advanced lung cancer, of whom 57% received palliative care. The relationship between palliative care and survival varied significantly based on when palliative care was received from the time of diagnosis: patients who received palliative care zero to 30 days from their diagnosis had a significantly decreased survival rate (adjusted hazard ratio [aHR], 2.13; 95% CI, 1.97-2.30), while those who received palliative care 31–365 days after diagnosis had a significantly increased survival rate (aHR, 0.47; 95% CI, 0.45-0.49). Palliative care received more than 365 days after diagnosis was not associated with survival (aHR, 1.00; 95% CI, 0.94-1.07) compared with nonreceipt of palliative care. Palliative care receipt, compared to nonreceipt, was correlated with a lower death risk in an acute care setting (adjusted odds ratio, 0.57; 95% CI, 0.52-0.64).
The authors wrote, in sum, “The results suggest that palliative care was associated with a survival benefit among patients with advanced lung cancer. Palliative care should be considered a complementary approach to disease-modifying therapy in patients with advanced lung cancer.”