PORTLAND, OR — While the term “palliative care” is usually associated with ameliorating pain and discomfort at the end of life, it appeared to have other benefits for veterans, according to a new study.
In this cohort study of 23 ,154 patients with advanced lung cancer treated at the VHA found that palliative care was associated with a survival benefit. The article in JAMA Oncology noted that the timing was important, because offering palliative care 31 to 365 days after diagnosis was linked to increased survival.1
In fact, VA Portland, OR, Healthcare System-led researchers suggested that, based on the findings of this study, palliative care should be considered a complementary approach to disease-modifying therapy in patients with advanced lung cancer.
Background information in the report noted that palliative care is a patient-centered approach associated with improvements in quality of life. It also pointed out that, with past research, results regarding its association with a survival benefit have been mixed, and, as a result, appeared to be underused at the VA.
The study team sought to assess whether early palliative care is associated with a survival benefit among patients with advanced lung cancer by conducting a retrospective population-based cohort study among patients with lung cancer who were diagnosed with cancer between Jan. 1, 2007, and Dec. 31, 2013, with follow-up until January 23, 2017, and analysis ending this past April. Included were 23,154 veterans who received care at the VHA.
Survival was defined as the primary outcome in the study, although the association between palliative care and place of death was also examined. Most, 57%, of the patients enrolled in the study received palliative care. The mean age of participants was 68, and 98% of participants were men.
Researchers reported that the examination of the timing of palliative care receipt relative to cancer diagnosis found that palliative care received 0 to 30 days after diagnosis was associated with decreases in survival (adjusted hazard ratio [aHR], 2.13; 95% CI, 1.97-2.30), palliative care received 31 to 365 days after diagnosis was associated with increases in survival (aHR, 0.47; 95% CI, 0.45-0.49), and palliative care received more than 365 days after diagnosis was associated with no difference in survival (aHR, 1.00; 95% CI, 0.94-1.07) compared with nonreceipt of palliative care.
The study team determined that receiving palliative care also was associated with a reduced risk of death in an acute care setting (adjusted odds ratio, 0.57; 95% CI, 0.52-0.64) compared with nonreceipt of palliative care.
“The results suggest that palliative care was associated with a survival benefit among patients with advanced lung cancer,” the authors wrote. “Palliative care should be considered a complementary approach to disease-modifying therapy in patients with advanced lung cancer.”
- Sullivan DR, Chan B, Lapidus JA, et al. Association of Early Palliative Care Use With Survival and Place of Death Among Patients With Advanced Lung Cancer Receiving Care in the Veterans Health Administration. JAMA Oncol. 2019;5(12):1702–1709. doi:10.1001/jamaoncol.2019.3105
