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Design and Participants: This retrospective cohort study examined how the timing and extent of PC involvement impacts outcomes and the patient experience in mNSCLC in the immunotherapy era. Electronic health record data was abstracted from adults with mNSCLC who initiated first-line treatment with chemotherapy, immunotherapy, or combined chemoimmunotherapy at Duke University Medical Center (2015-2019). Descriptive statistics, and chi-squared, Fisher’s, and Wilcoxon rank-sum tests were used.
Results: In total, 152 patients (aged mean=66 yrs [SD=9.9]; 57% male; 68% White and 96% non-Hispanic/Latino) were stratified based on whether PC was consulted; 53% never saw PC, while the 47% who saw PC were further stratified by time to first PC encounter and total number of visits. First-line therapies were chemotherapy (26%), combined chemoimmunotherapy (30%), single-agent immunotherapy (18%), and dual agent immunotherapy (26%). Thirty-one percent were seen within 2 months post-diagnosis (early), 33% between 2 and 6 months (intermediate), and 36% after 6 months (late). Patients who received early PC had more median time on hospice (35 days) vs those who received intermediate (11), late (18), and none (28) (P=.28). Patients who only saw PC while inpatient spent a median of 6 days on hospice. Overall, 43% with early PC received aggressive end-of-life care vs 65% intermediate, 65% late, and 64% none (P=.48); 14% of early PC group deaths were in hospital, vs 20% intermediate, 23% late, and 22% none (P=0.92).
Commentary: This study underscores the ongoing delay in timely palliative care integration for patients with mNSCLC, despite the 2017 American Society of Clinical Oncology recommendations. Although the benefits of PC are well established, services are introduced late in the disease course or not at all. These findings highlight the need for a structured, proactive approach to early PC involvement rather than reactive referrals, especially as immunotherapy continues to reshape treatment strategies. The results emphasize the importance of stronger collaboration with oncology teams to ensure early outpatient PC integration. This strategy not only enhances symptom management and goal-directed care but also reduces aggressive end-of-life interventions, ultimately improving the experiences of both patients and caregivers.
Bottom Line: Despite evidence supporting early palliative care in mNSCLC, late referrals remain common, emphasizing the need for proactive, structured integration to enhance patient-centered outcomes.
Reviewer: Ramandeep Kaur, MD MHA HMDC FAAHPM, Rush University Medical Center, Chicago, IL
References:
1. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733-742. doi:10.1056/NEJMoa1000678.
2. Ferrell BR, Temel JS, Temin S, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2017;35(1):96-112. doi:10.1200/JCO.2016.70.1474.
Source: Oswalt CJ, Nakatani MM, Troy J, et al. Timing of palliative care consultation impacts end of life care outcomes in metastatic non-small cell lung cancer. J Pain Symptom Manage. 2024;68(4):e325-e332. doi:10.1016/j.jpainsymman.2024.07.008.
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