Stepped Palliative Care for Patients With Advanced Lung Cancer: A Randomized Clinical Trial.

Area of Science:

• Oncology
• Palliative Care
• Health Services Research

Background:

• Early palliative care improves patient outcomes but faces implementation challenges due to workforce limitations.
• A need exists for resource-efficient and patient-centered palliative care models for advanced cancer patients.

Purpose of the Study:

• To evaluate a stepped-care palliative care model versus standard early palliative care for advanced cancer patients.
• To determine if the stepped-care model is noninferior in maintaining patient quality of life (QOL).

Main Methods:

• A randomized, nonblinded, noninferiority trial involving 507 advanced lung cancer patients across 3 academic medical centers.
• Stepped-care involved initial palliative care visits, with subsequent visits triggered by treatment changes or hospitalizations, and QOL monitoring.
• Early palliative care involved routine visits every 4 weeks.

Main Results:

• The stepped-care group received significantly fewer palliative care visits (2.4 vs 4.7) compared to the early palliative care group.
• Patient-reported QOL, measured by the Functional Assessment of Cancer Therapy-Lung (FACT-L) score at 24 weeks, was noninferior between the stepped-care and early palliative care groups (100.6 vs 97.8).
• Noninferiority was not demonstrated for days in hospice, with the stepped-care group having fewer days (19.5 vs 34.6).

Conclusions:

• A stepped-care palliative care model effectively reduces the number of palliative care visits while maintaining patient QOL.
• This model offers a scalable approach to deliver early palliative care and improve patient-reported outcomes.
• While associated with fewer hospice days, the stepped-care model's primary benefit lies in its efficiency and QOL preservation.