Comparative Effectiveness Trial of Early Palliative Care Delivered via Telehealth versus In Person Among Patients with Advanced Lung Cancer

Research

Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer A Multisite Randomized Clinical Trial

Executive Summary

Authors:
Joseph A. Greer, Chardria Trotter, Vicki Jackson (co-chair of Tuesday Health’s Clinical Advisory Board), Simone Rinaldi, Mihir Kamdar (Head of Clinical Delivery at Tuesday Health), Areej El-Jawahri (co-chair of Tuesday Health’s Clinical Advisory Board), Nora K. Horick, Kedie Pintro, Dustin Rabideau, Josephine Louella Feliciano, Isaac S. Chua, Konstantinos Leventakos, Stacy Fischer, Toby Christopher Campbell, Michael W. Rabow, Finly Zachariah, Laura C. Hanson, Sara F. Martin, Maria Silveira, Jennifer S. Temel

Executive Summary
Despite national guidelines recommending early integration of palliative and oncology care for advanced cancer patients to improve quality of life (QOL) and other outcomes, many patients do not receive early palliative care (EPC) in the outpatient setting due to limited access and resources. This study evaluates the effectiveness of EPC delivered via secure video versus in-person for patients with advanced non-small cell lung cancer (NSCLC) and their caregivers.

Key Findings

Study Population: The trial enrolled 1250 patients with advanced NSCLC across 22 U.S. cancer centers from June 2018 to May 2023. Participants (mean age 65.5 years; 54% female; 82.1% white) were randomized to relehealth or in-person early palliaitve care every four weeks.
Quality of Life: At 24 weeks, QOL scores were equivalent between the telehealth and in-person groups (adjusted means: 99.67 vs. 97.67, p < 0.043 for equivalence).
Caregiver Participation: Caregiver participation in EPC visits was lower in the telehealth group (36.6% vs. 49.7%, p < 0.0001).
Other Patient-Reported Outcomes: No significant differences were found between the telehealth and in-person groups regarding depression and anxiety symptoms, coping skills, or perceptions of treatment and prognosis.
Impact of COVID-19: Due to the pandemic, 3.9% of in-person visits were conducted via video.

Conclusion
The study demonstrates that early palliative care delivered through telehealth is equivalent to in-person visits in maintaining quality of life for patients with advanced NSCLC. Both delivery methods yielded similar results across various patient-reported measures, though caregiver participation was higher with in-person visits. These findings underscore the potential of telehealth to improve access to early palliative care, facilitating broader implementation of this evidence-based care model.

Greer, J., Trotter, C., Jackson, V., Rinaldi, S., Kamdar, M., El-Jawahri, A., Horick, N. K., Pintro, K., Rabideau, D., Feliciano, J. L., Chua, I. S., Leventakos, K., Fischer, S., Campbell, T. C., Rabow, M. W., Zachariah, F., Hanson, L. C., Martin, S. F., Silveira, M., & Temel, J. S. (2024). Comparative effectiveness of early palliative care delivered via telehealth versus in-person for patients with advanced non-small cell lung cancer: A randomized trial. *Journal of Clinical Oncology, 42*(suppl 17; abstr LBA3). https://doi.org/10.1200/JCO.2024.42.17_suppl.LBA3