Joseph A. Greer, PhD, on Lung Cancer: Telehealth vs In-Person Palliative Care

We've seen tremendous breakthroughs in novel therapeutics for lung cancer, which is incredibly exciting. At the same time, most patients with advanced lung cancer will, at some point along their disease trajectory, experience disabling physical and psychological symptoms, poor quality of life, financial stressors, and often, functional changes and worries about what the future might hold. Their caregivers, their loved ones, their friends and family share in this distress. To address these unmet needs, ASCO and other professional societies have recommended the early integration of palliative and oncology care from the time of diagnosis of advanced cancer. These guidelines are based on evidence from multiple clinical trials demonstrating the efficacy of early palliative care for improving quality of life, mood symptoms, coping, and other key outcomes in this vulnerable population. However, and unfortunately, most patients and their families do not receive this evidence-based care due to multiple barriers, chief among them being the limited availability of specialty trained palliative care clinicians. As our team was conceiving of a way to overcome these barriers, one potential solution that seemed highly feasible and potentially acceptable was the use of telehealth to deliver video visits for early palliative care. Therefore, we constructed a large-scale comparative effectiveness trial to test the delivery of early palliative care, either via video visits or in-person visits, for patients with advanced lung cancer and their families. The primary aim was to assess the equivalence of these two modalities on patient-reported quality of life at 24 weeks. We enrolled 1,250 patients and 548 caregivers, and randomly assigned them in a one-to-one fashion, either to early integrated palliative care delivered via video or early integrated palliative care delivered in person, in clinic. Those patients followed the same protocol in both study groups by meeting with the palliative care clinician at least every four weeks over the course of their illness. In addition, a patient and their caregiver would complete self-report measures of quality of life, satisfaction with care, their mood symptoms, and other self-report measures prior to randomization, and then again every 12 weeks up through 48 weeks. In our analysis of these data, we found that the two study groups demonstrated equivalent effects on patient-reported quality of life at 24 weeks. In addition, patients and caregivers also similarly reported no difference in their satisfaction with care whether the delivery of the care was via video or in person. And lastly, patients and caregivers did not report any differences in their mood symptoms. We are very pleased with these findings showing the equivalence between these two modalities for improving patient's quality of life as well as their caregiver outcomes. These findings have implications for improving access to early integrated palliative care, particularly for patients who live in far distances from their clinics, as well as for those who may be frail or have comorbid conditions that make getting to the clinic very challenging. Our hope is that these findings will inform policy decisions and advocates in trying to ensure the coverage of telehealth services for patients with advanced cancer so that they can continue to receive evidence-based early palliative care.