Over the past few decades, we have seen significant advances in cancer treatment that have led to improvements in survival rates for many patients. Despite these advances, individuals with advanced cancer often experience substantial symptom burden, psychological distress, and reduced quality of life (QOL). For patients with advanced cancer, palliative care has proven benefits and can help address these challenges; however, patients diagnosed with cancer are typically referred to palliative care late in their illness, often during hospitalization or when symptoms become debilitating.
The Benefits of Early Palliative Care
Numerous studies have shown that incorporating palliative care earlier in the course of cancer treatment, when a patient is first diagnosed with advanced disease, is not only feasible but can lead to meaningful improvements in their quality of life. In a landmark study from Mass General published in the New England Journal of Medicine, Jennifer Temel, MD, Joseph Greer, PhD, and colleagues demonstrated that in a group of patients with metastatic non-small cell lung cancer, those who received early palliative care along with standard treatment, experienced improved quality of life, reduced depressive symptoms, and prolonged survival compared to those receiving standard care alone.
While this research has challenged the misconception that palliative care is for end-of-life care, barriers to early palliative care persist. Because patients with advanced cancer are living longer and the number of palliative care specialists is limited, some hospitals, particularly smaller community or rural hospitals, have found it challenging to ensure that patients with advanced cancer receive palliative care earlier in the course of their illness.
Virtual Delivery of Palliative Care
Even before the use of telehealth to deliver cancer care surged during the COVID-19 pandemic, Drs. Greer and Temel were beginning to explore how virtual platforms could be used to deliver early palliative care in order to improve access to patients. Many oncology practices and hospitals now regularly use telehealth to deliver some forms of care, often routine follow-up visits. In a recent study, Drs. Greer and Temel and colleagues investigated whether palliative care could also be delivered virtually and as effectively as when delivered in person.
This randomized, multisite, comparative effectiveness trial was conducted between June 2018 and May 2023 at 22 cancer centers in the United States and included 1250 patients diagnosed with advanced non-small cell lung cancer (NSCLC) within the previous 12 weeks and 548 caregivers.
Participants were randomized to meet with a specialty-trained palliative care clinician every four weeks either via video visit or in person in the outpatient clinic from the time of enrollment and throughout the course of their disease. The video visit group had an initial in-person visit to establish rapport, followed by subsequent virtual visits. Quality of life was assessed with the Functional Assessment of Cancer Therapy-Lung questionnaire (score range: 0-136, with higher scores indicating better quality of life). Participants completed study questionnaires at enrollment and at weeks 12, 24, 36, and 48.
By 24 weeks, participants (mean age, 65.5 years; 54.0% women; 82.7% White) had a mean of 4.7 (video) and 4.9 (in-person) early palliative care encounters.
Patients in both groups reported similar improvements in quality of life, including improved appetite, reduced pain, and improved cognitive clarity. In addition, participants in both groups reported similar improvements in psychological symptoms, including anxiety and depression. Patients in both groups were also equally satisfied with the care they received.
Moving Forward
Palliative care is considered to be an essential element of cancer care that aims to improve the quality of life for patients with advanced disease. It is an approach that addresses the person as a whole, not just their disease, focusing on preventing or treating symptoms and side effects of the disease and its treatment, as well as the psychological, social, and spiritual challenges that come with the diagnosis. Numerous research studies indicate that palliative care can be provided alongside standard cancer treatments and that early integration of palliative care can lead to significant improvements in patient outcomes, including quality of life, psychological symptoms, and survival rates.
The current study from Greer and Temel demonstrates that the delivery of early palliative care virtually versus in person provides similar benefits for quality of life in patients with advanced NSCLC and underscores the considerable potential for improving access to this evidence-based care model through telehealth delivery.
The study results also have implications for the accessibility of palliative care. While palliative care delivered virtually may not appeal to all patients and may present challenges for those who lack access to the appropriate technology or those with hearing and visual impairment, telehealth provides a way for people with cancer who live in rural areas where there may not be many palliative care providers or who don’t have reliable transportation to receive palliative care.
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Greer JA, Temel JS, El-Jawahri A, Rinaldi S, Kamdar M, Park ER, Horick NK, Pintro K, Rabideau DJ, Schwamm L, Feliciano J, Chua I, Leventakos K, Fischer SM, Campbell TC, Rabow MW, Zachariah F, Hanson LC, Martin SF, Silveira M, Shoemaker L, Bakitas M, Bauman J, Spoozak L, Grey C, Blackhall L, Curseen K, O’Mahony S, Smith MM, Rhodes R, Cullinan A, Jackson V; REACH PC Investigators. Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer: A Multisite Randomized Clinical Trial. JAMA. 2024 Sep 11;332(14):1153-64.
Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010 Aug 19; 363(8):733-42. do
Temel JS, Petrillo LA, Greer JA. Patient-Centered Palliative Care for Patients With Advanced Lung Cancer. J Clin Oncol. 2022 Feb 20; 40(6):626-634.
Dr. Joseph Greer is Co-Director of the Cancer Outcomes Research & Education (CORE) Program at the Massachusetts General Hospital Cancer Center, a Clinical Psychologist in the MGH Center for Psychiatric Oncology & Behavioral Sciences, and an Associate Professor of Psychology at Harvard Medical School. Dr. Greer's clinical work focuses on the delivery of cognitive-behavioral therapy (CBT) to help patients and their families cope with cancer. In addition, he collaborates with a multidisciplinary research team to develop and test supportive care interventions aimed at improving quality of life, mood, and quality of care for patients with cancer.
Jennifer Temel, MD is the Clinical Director of Thoracic Oncology, Co-Director of the Cancer Outcomes Research and Education Program at the Mass General Hospital Cancer Center, and a Professor of Medicine at Harvard Medical School. Dr. Temel’s research focuses on optimizing palliative and supportive care for patients with cancer and their families. Her major research interest includes the study of early, integrated palliative care for patients with advanced cancers.
