Palliative Care Linked to Survival Benefit in Advanced Lung Cancer

By Marilynn Larkin

October 02, 2019

NEW YORK (Reuters Health) - Palliative care within a year of an advanced lung cancer diagnosis was associated with increases in survival and should be considered a complementary approach to disease-modifying therapy, authors of a retrospective study of U.S. veterans say.

"The biggest barriers are likely reduced capacity or availability of palliative care providers, and just a lack of referral by providers due to not realizing the potential benefits to patients," Dr. Donald Sullivan of the VA Portland Health Care System and Oregon Health Sciences University told Reuters Health by email.

"We still don't know which essential elements of palliative care contribute to improved patient outcomes, but this study goes a long way to dispel a common myth that palliative care decreases survival," he said. "Given the anticipated future needs of an aging population with multiple comorbidities in the United States, we need more education and palliative care training among non-palliative care providers to help bridge this gap."

Dr. Sullivan and colleagues analyzed data on 23,154 veterans with advanced lung cancer (mean age, 68; 98% men) diagnosed from 2007-2013 and followed to 2017.

As reported online September 19 in JAMA Oncology, 57% received palliative care, defined as a specialist-delivered palliative care encounter. During the study period, a 41% relative increase was noted in the use of palliative care in the VA system, with vide variations depending on the facility and region.

Palliative care received 0 to 30 days after diagnosis was associated with decreases in survival (adjusted hazard ratio, 2.13), whereas palliative care received 31 to 365 days after diagnosis was associated with increased survival (aHR, 0.47). By contrast, no survival difference was seen with palliative care received more than 365 days after diagnosis compared with no palliative care.

Among the entire cohort, 7,710 patients died in VA facilities, with 45% of those deaths in acute care settings. Receipt of palliative care was associated with a reduced risk of dying in an acute care setting (adjusted odds ratio, 0.57).

Dr. Sullivan said the lack of survival benefit with palliative care consults in the first 30 days "is all about context. Patients who received palliative care very soon after diagnosis - i.e., within 30 days - were likely seriously ill, as most of the initial encounters occurred in the inpatient setting, and this supportive approach was intended to ease the dying process rather than improve survival."

"Many of these patients only survived a few weeks after diagnosis in our study - some never leaving the hospital - and palliative care likely helped these patients transition to hospice, and offered bereavement support for their families," he said.

Dr. Ryan Nipp of Massachusetts General Hospital in Boston, coauthor of a related editorial, commented in an email to Reuters Health, "Importantly, although palliative care seeks to help patients live as well as possible for as long as possible, survival is not considered the primary goal."

"When describing the role of palliative care, clinicians should highlight the benefits related to symptom management, quality of life, and coping, and then consider the potential for survival benefits as a welcome side effect of palliative care," he said.

"Regardless of whether palliative care may sometimes help patients live longer, efforts to integrate palliative care alongside routine care should be driven by the goal of enhancing care delivery and outcomes for patients," he noted.

"Ongoing efforts are needed to help address misperceptions about the appropriateness and timing of palliative care," he said, "while also working to develop and test innovative care models that improve access to the benefits."


JAMA Oncol 2019.