Timing matters: early palliative care boosts lung cancer survival

  • JAMA Oncol

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Palliative care was associated with better OS in patients with advanced lung cancer if initiated between 31 and 365 days after diagnosis.

Why this matters

  • Despite studies suggesting a survival benefit, palliative care remains underused by patients, likely because of the perception that palliative care is for end-of-life care only.

Study design

  • 23,154 patients diagnosed with stage IIIB-IV lung cancer between 2007 and 2013 who received care in the Veterans Affairs (VA) health care system.
  • Funding: NIH; others.

Key results

  • 57% of patients received palliative care.
  • Palliative care use increased 41% during the study period.
  • Overall, palliative care was associated with poorer OS (aHR, 1.19; 95% CI, 1.15-1.23), but was timing dependent:
    • If initiated within 30 days of diagnosis, palliative care was associated with decreased OS (aHR, 2.13; 95% CI, 1.97-2.30).
    • If initiated within 31-365 days after diagnosis, palliative care was associated with improved OS (aHR, 0.47; 95% CI, 0.45-0.49).
    • No association with OS for palliative care initiated >365 days after diagnosis (aHR, 1.00; 95% CI, 0.94-1.07).
  • Receipt of palliative care was associated with decreased mortality in an acute care setting (aOR, 0.57; 95% CI, 0.52-0.64).

Limitations

  • Retrospective study in an all-VA patient setting.
  • Only 2% of participants were women.

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