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Design and Participants: This comparative effectiveness trial at 22 US cancer centers evaluated whether delivering early PC via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non–small cell lung cancer. Participants were randomized to meet with a specialty-trained PC clinician every 4 weeks via video (an initial in-person rapport-establishing visit, then virtual) or in person in the outpatient clinic from enrollment and throughout the disease course. The Functional Assessment of Cancer Therapy–Lung questionnaire measured equivalence of the effect of video vs in-person early PC on quality of life at 24 weeks (equivalence margin of ±4 points; range=0-136, higher indicating better quality of life). Participants completed questionnaires at enrollment and 12, 24, 36, and 48 weeks. Linear regression and t tests were used.
Results: Patients (n=633 video, n=617 in person) were aged mean 66 years (SD=11); 54% women; 83% White, 95% non-Hispanic/Latino; and 67% married/partnered. Fifty-nine percent identified a caregiver, of whom 79% enrolled (64% were spouse/partner). By 24 weeks, participants had a mean of 4.7 (video) and 4.9 (in person) early PC encounters. Between-group patient-reported quality-of-life scores were equivalent (video mean=100 vs in person 98; difference=2.0 [90% CI=0.1-3.9]; P=.04 for equivalence). Rate of caregiver participation in visits was lower for video vs in person (37% vs 50%; P<.001). Groups did not differ in caregiver quality of life; patient coping; or patient and caregiver satisfaction with care, mood symptoms, or prognostic perceptions.
Commentary: Federal rules for billable patient encounters were modified during the COVID-19 pandemic to advance telehealth as an alternative medium for healthcare delivery. Those rules will sunset December 31, 2024. Greer et al have demonstrated the equivalent effect of PC provided by telehealth and in-person encounters on quality of life for patients with non–small cell lung carcinoma. External validity may be limited by the racial and ethnic homogeneity of its subjects. This study provides salience for Congress to continue telehealth flexibility in PC delivery to patients with pain and poor functional status in rural areas with limited mobility or urban areas with heavy traffic imposing travel time and a cost burden. The practical implications of telehealth are its enhancement of palliative care access to this patient population.
Bottom Line: Telehealth PC clinic visits are equivalent to in person visits on quality-of-life impact for patients and their caregivers.
Reviewer: Edward J. Dunn, MD ScD, University of Louisville School of Medicine, University of Louisville Health Jewish Hospital, Louisville, KY
References:
1. Kavalieratos D, Corbelli J, Zhang D, et al. Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis. JAMA. 2016;316(20):2104-2114. doi:10.1001/jama.2016.16840.
2. Haun MW, Estel S, Rücker G, et al. Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev. 2017;6(6):CD011129. doi:10.1002/14651858.CD011129.pub2.
3. Huo B, Song Y, Chang L, Tan B. Effects of early palliative care on patients with incurable cancer: a meta-analysis and systematic review. Eur J Cancer Care (Engl). 2022;31(6):e13620. doi:10.1111/ecc.13620.
Source: Greer JA, Temel JS, El-Jawahri A, et al. Telehealth vs in-person early palliative care for patients with advanced lung cancer: a multisite randomized clinical trial. JAMA. 2024:e2413964. doi:10.1001/jama.2024.13964.
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