Can telemedicine palliate patients with NSCLC?
Do patients with NSCLC receive early palliative care?
Best practice early palliative and oncology care for patients with advanced non-small cell lung cancer (NSCLC) is an integrated model for symptom management, quality of life (QoL) improvement, and support for patients, their families or caregivers.1,2 However, many outpatients do not receive early palliative care (EPC) due to poor access and/or limited resources. Could EPC delivered through telehealth improve outcomes for outpatients?3
At the 2024 American Society of Clinical Oncology Genitourinary (ASCO GU) Cancers Symposium, Dr Joseph Greer (Cancer Outcomes Research & Education Program, Massachusetts General Hospital Cancer Center, Boston, USA) presented outcome data from the large-scale REACH PC trial, which compared the effectiveness of EPC delivered through video with in-person care for patients with advanced NSCLC.
The REACH PC trial
Methods
Between 2018 and 2023, 1,250 patients with advanced NSCLC, diagnosed in the previous 12 weeks, were enrolled in the trial across 22 US cancer centres.
- Patients were randomised to receive palliative care consultations by video or in the outpatient clinic, every 4 weeks
- Participants completed self-report measures at baseline and weeks 12, 24, 36, and 48
- The two groups were compared for caregiver involvement in EPC visits, patient-reported depression and anxiety symptoms, coping, and perceptions of prognosis
- Primary outcome: QoL at 24 weeks, as assessed by Functional Assessment of Cancer Therapy-Lung (FACT-L)
Key results
Participants (mean age 65.5 years; 54.0% female; 82.1% White) had a mean of 4.75 and 4.92 EPC consultations by week 24 in the telehealth and in-person groups, respectively.
For patients assigned to the telehealth group, QoL scores at week 24 were equivalent to patients receiving in-person EPC (adjusted mean scores: 99.67 vs 97.67, P<0.043 for equivalence). The caregiver participation rate in EPC visits was lower in the telehealth versus in-person group (36.6% vs 49.7%; P<0.001).
Study groups did not differ in depression and anxiety symptoms, coping skills, or perceptions of the goal of treatment and curability of NSCLC.
REACH PC: Takeaways
Palliative care led to equivalent benefits for patient-reported quality of life whether delivered via video or in-person visits among adults with advanced lung cancer…findings underscore the potential to increase access to evidence-based early palliative care through telehealth delivery.
- Dr Joseph Greer
Telehealth for NSCLC: Next steps?
Investigations should compare the benefits of telehealth versus in-person care for diverse patient subgroups, with focus on age and competency with technology. The effects of care delivery on the quality of end-of-life treatment, especially for patient–clinician communication about care preferences, should be considered for investigation.
Revisit ASCO GU 2024: Dr Shore analyses the BRCAAway trial
References
- ASCO, 2024. Palliative care for patients with cancer: ASCO guideline update. https://www.doi.org/10.1200/jco.24.00542
- ASCO, 2024. Palliative care for patients with cancer: ASCO guideline clinical insights. https://www.doi.org/10.1200/OP.24.00225
- Patel, 2023. Estimated indirect cost savings of using telehealth among nonelderly patients with cancer. https://www.doi.org/10.1001/jamanetworkopen.2022.50211