In the Journals

Palliative care linked to survival benefit in advanced lung cancer

Photo of Donald Sullivan 2018
Donald Sullivan

Palliative care appeared associated with survival benefits among patients with advanced lung cancer, according to results of a retrospective study published in JAMA Oncology.

“Lung cancer populations are unique in some ways and usually suffer from increased physical and mental health symptom burden — including higher rates of depression symptoms — and very poor prognosis compared with other cancer populations,” Donald Sullivan, MD, associate professor of medicine and associate fellowship program director in the division of pulmonary and critical care medicine at Oregon Health & Science University, told HemOnc Today. “For patients who have a lot of supportive care needs or advanced disease ... I think results would be comparable.”

Palliative care focuses on improving patients’ quality of life through symptom and stress relief. However, studies have yielded mixed results regarding its association with survival benefits.

Sullivan and colleagues retrospectively analyzed data on 23,154 patients (mean age, 68 years; 98% men) with advanced lung cancer diagnosed between 2007 and 2013 who obtained care in the Veterans Affairs health care system to determine whether early use of palliative care was associated with survival benefits.

Most of the patients (57%; n = 13,109) received palliative care, and researchers noted a 41% relative increase in palliative care use during the 7-year study period.

Survival served as the primary endpoint. Researchers also examined the association between palliative care and place of death.

Results showed that receipt of palliative care within 30 days after lung cancer diagnosis appeared associated with decreased survival (adjusted HR [aHR] = 2.13; 95% CI, 1.97-2.3) compared with no palliative care. However, palliative care received 31 days to 365 days after diagnosis appeared associated with increased survival (aHR = 0.47; 95% CI, 0.45-0.49), whereas palliative care received more than 1 year after diagnosis had no effect on survival (aHR = 1; 95% CI, 0.94-1.07) compared with no palliative care.

“Those who received palliative care within 30 days of diagnosis were likely more seriously ill, as most of these patients received palliative care during inpatient hospitalizations and many only lived 1 to 2 weeks after diagnosis,” Sullivan said. “Palliative care for these patients likely consisted of goals-of-care conversations, referral to hospice and/or bereavement support for families. Palliative care received 31 to 365 days after diagnosis was associated with a survival benefit, as these patients were more often seen in the outpatient setting and were able to take advantage of the multidisciplinary, holistic approach of this care.”

Results also showed palliative care lowered the risk for death in an acute care setting (adjusted OR = 0.57; 95% CI, 0.52-0.64) vs. no palliative care.

The study’s retrospective nature served as its primary limitation.

“We don’t know yet what exactly about palliative care contributes to survival, but I think symptom management, particularly mental health, and improved quality of life are the main drivers,” Sullivan said. “Further evidence of this upstream, earlier approach is that outpatient palliative care — regardless of timing — was associated with better survival. So, the important message is that earlier palliative care has an associated survival benefit compared with no palliative care.”

The goal of palliative care should be to enhance quality of life, not necessarily to prolong survival, Ryan Nipp, MD, gastrointestinal oncologist at Massachusetts General Hospital, and colleagues wrote in an accompanying editorial.

“Although palliative care may sometimes help patients live longer, the decision to involve palliative care should not be driven by the expectation of potential survival benefits but rather by the principle that early palliative care can enhance the quality of life and care for both patients and their loved ones,” Nipp and colleagues wrote. “Importantly, future efforts should build upon the results of the current study to address ongoing misperceptions about the appropriateness and timing of palliative care while also seeking to develop novel models of care to enhance care access and efficient use of palliative care services.” – by John DeRosier

For more information:

Donald Sullivan, MD, can be reached at: sullivad@ohsu.edu.

Disclosures: Sullivan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. One editorial author reports grants from Pfizer outside the submitted work. The other editorial authors report no relevant financial disclosures.

Photo of Donald Sullivan 2018
Donald Sullivan

Palliative care appeared associated with survival benefits among patients with advanced lung cancer, according to results of a retrospective study published in JAMA Oncology.

“Lung cancer populations are unique in some ways and usually suffer from increased physical and mental health symptom burden — including higher rates of depression symptoms — and very poor prognosis compared with other cancer populations,” Donald Sullivan, MD, associate professor of medicine and associate fellowship program director in the division of pulmonary and critical care medicine at Oregon Health & Science University, told HemOnc Today. “For patients who have a lot of supportive care needs or advanced disease ... I think results would be comparable.”

Palliative care focuses on improving patients’ quality of life through symptom and stress relief. However, studies have yielded mixed results regarding its association with survival benefits.

Sullivan and colleagues retrospectively analyzed data on 23,154 patients (mean age, 68 years; 98% men) with advanced lung cancer diagnosed between 2007 and 2013 who obtained care in the Veterans Affairs health care system to determine whether early use of palliative care was associated with survival benefits.

Most of the patients (57%; n = 13,109) received palliative care, and researchers noted a 41% relative increase in palliative care use during the 7-year study period.

Survival served as the primary endpoint. Researchers also examined the association between palliative care and place of death.

Results showed that receipt of palliative care within 30 days after lung cancer diagnosis appeared associated with decreased survival (adjusted HR [aHR] = 2.13; 95% CI, 1.97-2.3) compared with no palliative care. However, palliative care received 31 days to 365 days after diagnosis appeared associated with increased survival (aHR = 0.47; 95% CI, 0.45-0.49), whereas palliative care received more than 1 year after diagnosis had no effect on survival (aHR = 1; 95% CI, 0.94-1.07) compared with no palliative care.

“Those who received palliative care within 30 days of diagnosis were likely more seriously ill, as most of these patients received palliative care during inpatient hospitalizations and many only lived 1 to 2 weeks after diagnosis,” Sullivan said. “Palliative care for these patients likely consisted of goals-of-care conversations, referral to hospice and/or bereavement support for families. Palliative care received 31 to 365 days after diagnosis was associated with a survival benefit, as these patients were more often seen in the outpatient setting and were able to take advantage of the multidisciplinary, holistic approach of this care.”

PAGE BREAK

Results also showed palliative care lowered the risk for death in an acute care setting (adjusted OR = 0.57; 95% CI, 0.52-0.64) vs. no palliative care.

The study’s retrospective nature served as its primary limitation.

“We don’t know yet what exactly about palliative care contributes to survival, but I think symptom management, particularly mental health, and improved quality of life are the main drivers,” Sullivan said. “Further evidence of this upstream, earlier approach is that outpatient palliative care — regardless of timing — was associated with better survival. So, the important message is that earlier palliative care has an associated survival benefit compared with no palliative care.”

The goal of palliative care should be to enhance quality of life, not necessarily to prolong survival, Ryan Nipp, MD, gastrointestinal oncologist at Massachusetts General Hospital, and colleagues wrote in an accompanying editorial.

“Although palliative care may sometimes help patients live longer, the decision to involve palliative care should not be driven by the expectation of potential survival benefits but rather by the principle that early palliative care can enhance the quality of life and care for both patients and their loved ones,” Nipp and colleagues wrote. “Importantly, future efforts should build upon the results of the current study to address ongoing misperceptions about the appropriateness and timing of palliative care while also seeking to develop novel models of care to enhance care access and efficient use of palliative care services.” – by John DeRosier

For more information:

Donald Sullivan, MD, can be reached at: sullivad@ohsu.edu.

Disclosures: Sullivan reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures. One editorial author reports grants from Pfizer outside the submitted work. The other editorial authors report no relevant financial disclosures.