Telehealth Palliative Care Visits Equivalent to In-Person for Patients With Advanced NSCLC

Delivery of early palliative care via telehealth video as compared with in-person visits provided equivalent effects in terms of quality of life for patients with advanced non-small cell lung cancer (NSCLC), according to recently presented data.

These findings underscore the potential to increase access to evidence-based early palliative care through telehealth delivery, according to Joseph A. Greer, PhD, of Harvard Medical School, who presented the study results at the 2024 American Society of Clinical Oncology Annual Meeting.

“A new diagnosis of advanced lung cancer provokes a range of physical, psychosocial, and existential concerns including changes in functioning as well as worries about what the future will hold,” Dr. Greer said. “Family members and friends share in this distress.”

Recommendations from the American Society of Clinical Oncology and other organizations recommend the integration of palliative care from the time of diagnosis. Unfortunately, most patients do not receive this evidence-based care.

Dr. Greer acknowledged that since the COVID-19 pandemic, many institutions have the ability to offer telehealth visits, but whether the modality is as effective as in-person care for improving patient outcomes remains unknown.

To look at the effectiveness of telehealth palliative care, Dr. Greer and colleagues enrolled 1,250 patients with advanced NSCLC who had been diagnosed in the last 12 weeks. All patients were randomly assigned to palliative care consultation every four weeks either via video or at an outpatient clinic. Self-reported measures were collected at baseline, week 12, week 24, week 36 and week 48. Dr. Greer reported on the week 24 outcomes.

By week 24, patients in both groups had completed an average of about 5 palliative care encounters. Notably, because of the COVID-19 pandemic, a small percentage (6%) of visits in the in-person group had to be completed via video; however, no other visits were done in-person prior to the pandemic.

Among the most frequently discussed topics were assessing and managing symptoms and supporting use of coping skills. Fewer than half of the visits focused on illness understanding, advanced-care planning, or treatment decisions. Discussed topics were similar between the two modalities.

Patient-reported quality-of-life scores at week 24 were equivalent for the 2 groups (P=.04 for equivalence). Patient-reported and caregiver-reported satisfaction with care was also similar between the 2 groups.

Contrary to the researchers’ hypothesis, the rate of caregiver participation in the palliative care visits was lower among participants assigned to video visits as compared with in-person visits (36.6% vs. 49.7%; P<.0001).

“These study findings add critical evidence to support ongoing access to telehealth services especially for vulnerable populations with serious illness,” Dr. Greer said.

Reference

Greer JA, Trotter C, Jackson V, et al. Comparative effectiveness trial of early palliative care delivered via telehealth versus in person among patients with advanced lung cancer. Presented at the 2024 American Society of Clinical Oncology Annual Meeting; May 31-June 4, 2024, Chicago, Illinois.