Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer
Author:
Greer Joseph A.12, Temel Jennifer S.23, El-Jawahri Areej23, Rinaldi Simone3, Kamdar Mihir23, Park Elyse R.123, Horick Nora K.3, Pintro Kedie3, Rabideau Dustin J.23, Schwamm Lee4, Feliciano Josephine5, Chua Isaac67, Leventakos Konstantinos8, Fischer Stacy M.9, Campbell Toby C.10, Rabow Michael W.11, Zachariah Finly12, Hanson Laura C.13, Martin Sara F.14, Silveira Maria1516, Shoemaker Laura17, Bakitas Marie18, Bauman Jessica19, Spoozak Lori20, Grey Carl21, Blackhall Leslie22, Curseen Kimberly23, O’Mahony Sean24, Smith Melanie M.25, Rhodes Ramona26, Cullinan Amelia27, Jackson Vicki23, , Trotter Chardria28, Gallagher Medeiros Emily28, Calton Brooke A.28, Carlson Heather A.28, Cartagena Leslie28, Diop Michelle28, Evans Theresa28, Jackson James G.28, O’Brien Karen28, Petrillo Laura A.28, Shin Jennifer S.28, Browner Ilene28, Gray Nathaniel28, Awad Mark28, Tulsky James28, Christensen Kelly J.28, Rhee Laura S.28, Strand Jacob28, Gilhuly Devin28, Rondinelli Nicole28, Seibert Jennifer28, Treem Jonathan28, Schueller Kate28, Allen Gregory28, Blakely Collin28, Gubens Matthew28, Lindenfeld Paul28, Mulvey Claire28, Young Natalie28, Dale William28, Luna Joanna28, Mecusker Eric28, Moreno Jeanine28, Ramirez Carey28, Williams Sari28, Gaffney Sean28, Kelly Cynthia28, Lavin Kyle28, Iams Wade28, Robbins Samuel G.28, Kalemkerian Greg28, Lagman Ruth28, Neale Kyle28, Patel Chirag28, Samala Renato28, Weinstein Elizabeth28, McCammon Susan28, Taylor Richard28, Tucker Rodney28, Chwistek Marcin28, Collins Molly28, Edelman Martin28, Judd Julia28, Kinczewski Leigh28, Murphy Kathleen28, Sherry Dylan28, Welsh Marie28, Sinclair Christian28, Wulff-Burchfield Elizabeth28, Gabbard Jennifer28, Statler Tiffany28, Timmins Nathaniel28, Kavalieratos Dio28, Lowers Jane28, Quest Tammie28, Chen Elaine28, LaBellarte Giulia28, Mohinda Nisha28, Munger Natalie K.28, Munroe Michelle28, Patel Jyoti D.28, Szmuilowicz Eytan28, Vermylen Julia H.28, Siropaides Caitlin H.28, Ahern Christopher G.28, Kobin Emily G.28, Vergo Maxwell T.28, Wilson Matthew M.28
Affiliation:
1. Department of Psychiatry, Massachusetts General Hospital, Boston 2. Harvard Medical School, Boston, Massachusetts 3. Department of Medicine, Massachusetts General Hospital, Boston 4. Division of Vascular Neurology and Department of Biomedical Informatics and Data Science, Yale School of Medicine, New Haven, Connecticut 5. Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland 6. Department of Psychosocial Oncology and Palliative Medicine, Dana-Farber Cancer Institute, Boston, Massachusetts 7. Division of General Internal Medicine and Primary Care, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts 8. Department of Oncology and Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Rochester, Minnesota 9. Department of Medicine, Division of General Internal Medicine, University of Colorado School of Medicine, Aurora 10. Department of Medicine, University of Wisconsin–Madison, Madison 11. Department of Medicine, University of California San Francisco, San Francisco 12. Department of Supportive Care Medicine, City of Hope, Duarte, California 13. Division of Geriatric Medicine, Palliative Care and Hospice Program, University of North Carolina at Chapel Hill 14. Division of General Internal Medicine and Public Health, Section of Palliative Care, Vanderbilt University Medical Center, Nashville, Tennessee 15. Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor 16. Geriatrics Research Education and Clinical Center, Lieutenant Colonel Charles S. Kettles VA Medical Center, Ann Arbor, Michigan 17. Department of Palliative and Supportive Care, Cleveland Clinic, Taussig Cancer Institute, Cleveland, Ohio 18. School of Nursing and Center for Palliative and Supportive Care, University of Alabama at Birmingham 19. Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 20. Obstetrics and Gynecology and Palliative Medicine, University of Kansas School of Medicine, Kansas City 21. Department of Internal Medicine, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina 22. Department of General Medicine, Hospice and Palliative Medicine, University of Virgina School of Medicine, Charlottesville 23. Division of Palliative Medicine, Department of Family and Preventive Medicine, Emory University, Emory School of Medicine, Atlanta, Georgia 24. Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois 25. Division of Hospital Medicine, Section of Palliative Care, Department of Medicine, Northwestern Medicine, Feinberg School of Medicine, Chicago, Illinois 26. Department of Internal Medicine and Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas 27. Department of Medicine, Dartmouth-Hitchcock Health, Lebanon, New Hampshire 28. for the REACH PC Investigators
Abstract
ImportanceNumerous 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.ObjectiveTo 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 ParticipantsRandomized, 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.InterventionParticipants 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 MeasuresEquivalence 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.ResultsBy 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 < .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 RelevanceThe 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 RegistrationClinicalTrials.gov Identifier: NCT03375489
Publisher
American Medical Association (AMA)
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