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Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer
Abstract
BACKGROUND: Patients with metastatic non-small-cell lung cancer have a substantial symptom burden and may receive aggressive care at the end of life. We examined the effect of introducing palliative care early after diagnosis on patient-reported outcomes and end-of-life care among ambulatory patients with newly diagnosed disease. METHODS: We randomly assigned patients with newly diagnosed metastatic non-small-cell lung cancer to receive either early palliative care integrated with standard oncologic care or standard oncologic care alone. Quality of life and mood were assessed at baseline and at 12 weeks with the use of the Functional Assessment of Cancer Therapy-Lung (FACT-L) scale and the Hospital Anxiety and Depression Scale, respectively. The primary outcome was the change in the quality of life at 12 weeks. Data on end-of-life care were collected from electronic medical records. RESULTS: Of the 151 patients who underwent randomization, 27 died by 12 weeks and 107 (86% of the remaining patients) completed assessments. Patients assigned to early palliative care had a better quality of life than did patients assigned to standard care (mean score on the FACT-L scale [in which scores range from 0 to 136, with higher scores indicating better quality of life], 98.0 vs. 91.5; P=0.03). In addition, fewer patients in the palliative care group than in the standard care group had depressive symptoms (16% vs. 38%, P=0.01). Despite the fact that fewer patients in the early palliative care group than in the standard care group received aggressive end-of-life care (33% vs. 54%, P=0.05), median survival was longer among patients receiving early palliative care (11.6 months vs. 8.9 months, P=0.02). CONCLUSIONS: Among patients with metastatic non-small-cell lung cancer, early palliative care led to significant improvements in both quality of life and mood. As compared with patients receiving standard care, patients receiving early palliative care had less aggressive care at the end of life but longer survival. (Funded by an American Society of Clinical Oncology Career Development Award and philanthropic gifts; ClinicalTrials.gov number, NCT01038271.)
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“Previous studies have demonstrated the benefit of early integration of palliative care (PC) in oncology.”
In the citing paper
“Furthermore, they found that the patients who received early PC were submitted to fewer aggressive treatments in the final stages of life.”
In the citing paper
“A post-hoc analysis inclusively demonstrated a 2.7-month increase in the overall survival rate of patients who received PC.”
In the citing paper
“Temel et al. [6] evaluated the early integration of PC in non-small cell lung cancer patients who were starting first-line palliative chemotherapy. An improvement in the QL scores and a decrease in the symptoms of depression were evident 12 weeks after randomization.”
In the citing paper
“In distinction from chemotherapy after the second-line setting, palliative care has been associated with equal103–106 or longer107–109 survival in randomized and nonrandomized110 trials of patients with advanced cancer.”
From Systemic Therapy for Stage IV Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update (2015) · cites this paper as [106]
In the citing paper
“In addition, a cluster RCT published since the provisional clinical opinion, which included participants with NSCLC, showed important improvements in QoL, symptoms, and caregiver distress.106”
From Systemic Therapy for Stage IV Non–Small-Cell Lung Cancer: American Society of Clinical Oncology Clinical Practice Guideline Update (2015) · cites this paper as [106]
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Metadata
- Authors
- Temel, J. S., Greer, J. A., Muzikansky, A., Gallagher, E. R., Admane, S., Jackson, V. A., Dahlin, C. M., Blinderman, C. D., Jacobsen, J., Pirl, W. F., Billings, J. A., & Lynch, T. J.
- Affiliations
- Massachusetts General Hospital (US)
- University at Buffalo, State University of New York (US)
- Columbia University Irving Medical Center (US)
- Yale University (US)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2010-08-19
- Volume
- 363
- Issue
- 8
- Pages
- 733-742
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2147016542
- Semantic Scholar
- 0cd2002df2a3b3cdf8d351b2a4a7273463c2f318
- Cited by
- 7,482
- References
- 38
- Citations by year
- 2026: 384 · 2025: 413 · 2024: 447 · 2023: 455 · 2022: 513 · 2021: 530 · 2020: 523 · 2019: 515 · 2018: 540 · 2017: 595 · 2016: 528 · 2015: 480 · 2014: 452 · 2013: 405 · 2012: 358
- FWCI
- 344.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Lung Cancer Diagnosis and Treatment
- Keywords
- early palliative care, metastatic non-small cell lung cancer, quality of life, depressive symptoms, end-of-life care, aggressive end-of-life care, survival, patient-reported outcomes, newly diagnosed cancer, outpatients
- MeSH terms
- Affect, Aged, Carcinoma, Non-Small-Cell Lung, Depression, Female, Humans, Lung Neoplasms, Male, Middle Aged, Palliative Care, Quality of Life, Terminal Care, Time Factors, Linear Models, Kaplan-Meier Estimate
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