Tailored palliative care model improves quality of life in ‘effective and scalable way’
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Key takeaways:
- Patients using stepped palliative care model had fewer mean visits by week 24.
- Those who received stepped care had markedly fewer mean days in hospice.
CHICAGO — A stepped palliative care model delivering early care at key points for patients with advanced cancer resulted in fewer visits while still maintaining quality-of-life benefits, results from a randomized study showed.
According to the data presented at ASCO Annual Meeting and simultaneously published in JAMA, patients assigned to the stepped model spent fewer days in hospice.
“Stepped palliative care is an effective and scalable way to deliver early palliative care to improve patients’ quality of life,” Jennifer S. Temel, MD, a professor of medicine at Harvard Medical School and director of the cancer outcomes research program at Massachusetts General Hospital Cancer Center, said during a presentation. “The primary barrier to implementing this care model will likely be the requirement for close monitoring of patients’ illness course and administering measures to monitor their quality of life.”
Background and methodology
Palliative care workforce limitations have prevented the wide adoption and implementation of early palliative care, despite evidence highlighting its ability to improve outcomes in patients.
Researchers conducted a nonblinded, noninferiority trial to evaluate whether a stepped-care model could deliver less resource-intensive, more patient-centered palliative care for patients with advanced cancers.
The trials took place at three academic medical centers in Boston, Philadelphia, and Durham, North Carolina, between Feb. 12, 2018, and Dec. 15, 2022.
The study included 507 patients (mean age, 66.5 years; 51.4% women; 84.6% white) diagnosed with advanced lung cancer within the past 12 weeks who had an ECOG performance status of 0 to 2. More than three-quarters (78.3%) of the study population had advanced non-small cell lung cancer.
Patients assigned to the stepped palliative care cohort started on step 1, which included an initial palliative care visit within 4 weeks of study enrollment and subsequent palliative care visits scheduled at time of a change in cancer treatment or following potential hospitalizations.
Additionally, patients in the stepped palliative care cohort also completed a measure of quality of life every 6 weeks, for up to 18 months following enrollment; patients with a greater than or equal to 10-point decrease in their respective score from baseline stepped up to meet with their palliative care clinician every 4 weeks.
Patients assigned to the early palliative care cohort had visits every 4 weeks from study enrollment.
Noninferiority (margin = 4.5) of the effect of stepped vs. early palliative care on patient-reported quality of life, as measured by the Functional Assessment of Cancer Therapy-Lung at week 24, served as the study’s primary endpoint.
Results, next steps
Researchers reported noninferior quality of life scores at week 24 for patients assigned to stepped palliative care compared with patients who received early palliative care (adjusted means: 100.6 vs. 97.8).
Sixty-six patients (26.4%) assigned to specialist palliative care transitioned to step 2 by 24 weeks; the mean number of palliative care visits by week 24 trended lower for patients receiving stepped palliative care than for those receiving early palliative care (adjusted means: 2.4 vs. 4.7).
Although the rate of end-of-life care communication showed statistical noninferiority between the two groups, researchers did not find noninferiority for days in hospice (adjusted mean, 19.5 days with stepped palliative care vs. 34.6 days with early palliative care).
“Delivering early palliative care at key points in patients’ cancer trajectories and monitoring quality of life to trigger more intensive exposure results in fewer visits while maintaining the benefits for patients’ quality of life,” Temel said. “Additional or alternative care models are needed to ensure timely referral for hospice services, and future studies should integrate a strategy — such as machine learning prognostic algorithms — to identify patients who are in the last month of life who need to step up to more intensive palliative care exposure.”
References:
- Temel JS, et al. Abstract 12000. Presented at: ASCO Annual Meeting 2024; May 30 – June 4, 2024; Chicago.
- Temel JS, et al. JAMA. 2024;doi:10.1001/jama.2024.10398.
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Temel JS, et al. Abstract 12000. Presented at: ASCO Annual Meeting 2024; May 30 – June 4, 2024; Chicago.
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