Dr Oswalt on the Effects of Palliative Care Timing on End-of-Life Care in mNSCLC

Cameron James Oswalt MD, fellow, Hematology-Oncology, assistant professor, medicine, Department of Medicine, Duke University School of Medicine, discusses findings from a study evaluating the timing of palliative care referral and its effect on end-of-life care outcomes in patients with metastatic non–small cell lung cancer (mNSCLC).

This study included 152 patients from the Duke Tumor Registry who were diagnosed with mNSCLC between March 2015 and June 2019. Investigators found that fewer than half of patients received palliative care during their treatment course, and fewer than one-third of the patients who received palliative care accessed this care within 2 months of diagnosis, Oswalt begins. Specifically, among the 152 patients analyzed, 80 had no palliative care visits, and 22 received early palliative care. These findings are notable given the existing evidence that early palliative care referral improves patient quality of life and outcomes, Oswalt emphasizes. The low referral rate in this cohort could be attributed to several factors, including patient preferences, preconceived notions, barriers to referral, and overall disease burden, he says. Among patients who died, 59.1% were enrolled in hospice.

Key end-of-life care outcomes assessed in this study included time on hospice, incidence of aggressive end-of-life care, and in-hospital death. Investigators found that patients who received early palliative care had longer hospice stays, reduced rates of aggressive end-of-life care, and fewer in-hospital deaths compared with those who received late or no palliative care. Additionally, the early palliative care group had an average hospice stay of 53.6 days, compared with 24.9 to 38.8 days in other groups. Similar trends were noted for rates of aggressive end-of-life care and in-hospital death, reinforcing the potential benefits of early palliative care, Oswalt reports.

Oswalt notes that the study’s sample sizes were small; as a result, none of the outcomes reached statistical significance. However, these findings underscore the importance of timely palliative care referral, he concludes.