6009 Background: Although we recently observed that introducing palliative care soon after diagnosis for patients with metastatic NSCLC is associated with better quality of life, mood, and survival, the degree to which this care model impacts medical treatment at the end of life requires further study. The aim of this follow-up analysis was to examine the effect of early palliative care on the frequency and timing of chemotherapy utilization and hospice care among patients with metastatic NSCLC.
METHODS
In this randomized controlled trial, we enrolled 151 patients with newly-diagnosed, metastatic NSCLC presenting to the Massachusetts General Hospital Cancer Center between 6/06 and 7/09. We randomly assigned patients within eight weeks after diagnosis to receive early palliative care integrated with standard oncology care (N=77) or standard oncology care alone (N=74). Participants in the intervention group consulted with palliative care clinicians at least monthly until death. Using Fisher's exact and log-rank tests, we analyzed differences in the: 1) number and types of chemotherapy regimens; and 2) frequency and timing of chemotherapy administration and referral to hospice care.
RESULTS
By one-year follow up, 128 (84.8%) participants had died. Study groups did not differ significantly with respect to the number of chemotherapy regimens or time to second-line or third-line administration. However, compared to those in the standard care group, participants receiving early palliative care had a lower rate of intravenous chemotherapy utilization within 60 days of death (24.1% vs 47.0%, p=0.009), a longer interval between the last dose of intravenous chemotherapy and death (median days=64 vs 41, p=0.01), and higher enrollment in hospice care for greater than one week before death (59.6% vs 33.8%, p=0.006). Early palliative care did not impact utilization of oral chemotherapy.
CONCLUSIONS
Although patients with metastatic NSCLC received similar numbers of chemotherapy regimens in the sample, early palliative care optimized the timing of final administration of intravenous chemotherapy and transition to hospice services, key measures of quality end-of-life care.