Donald R Sullivan1,2,3, Benjamin Chan4, Jodi A Lapidus4, Linda Ganzini2,5, Lissi Hansen6, Patricia A Carney7, Erik K Fromme8,9, Miguel Marino4,7, Sara E Golden2, Kelly C Vranas1,2, Christopher G Slatore1,2,3,10. 1. Division of Pulmonary and Critical Care Medicine, Department of Medicine, Oregon Health and Science University, Portland. 2. Health Services Research and Development, Veterans Affairs Portland Health Care System, Portland, Oregon. 3. Cancer Prevention and Control Program, Knight Cancer Institute, Oregon Health and Science University, Portland. 4. Biostatistics, School of Public Health, Oregon Health and Science University, Portland. 5. Department of Psychiatry, Oregon Health and Science University, Portland. 6. School of Nursing, Oregon Health and Science University, Portland. 7. Department of Family Medicine, Oregon Health and Science University, Portland. 8. Serious Illness Care Program, Ariadne Labs, Boston, Massachusetts. 9. Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts. 10. Section of Pulmonary and Critical Care Medicine, Veterans Affairs Portland Health Care System, Portland, Oregon.
Abstract
Importance: Palliative care is a patient-centered approach associated with improvements in quality of life; however, results regarding its association with a survival benefit have been mixed, which may be a factor in its underuse. Objective: To assess whether early palliative care is associated with a survival benefit among patients with advanced lung cancer. Design, Setting, and Participants: This retrospective population-based cohort study was conducted among patients with lung cancer who were diagnosed with cancer between January 1, 2007, and December 31, 2013, with follow-up until January 23, 2017. Participants comprised 23 154 patients with advanced lung cancer (stage IIIB and stage IV) who received care in the Veterans Affairs health care system. Data were analyzed from February 15, 2019, to April 28, 2019. Exposure: Palliative care defined as a specialist-delivered palliative care encounter received after lung cancer diagnosis. Main Outcomes and Measures: The primary outcome was survival. The association between palliative care and place of death was also examined. Propensity score and time-varying covariate methods were used to calculate Cox proportional hazards and to perform regression modeling. Results: Of the 23 154 patients enrolled in the study, 57% received palliative care. The mean (SD) age of participants was 68 (9.5) years, and 98% of participants were men. An 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. Receipt of palliative care was also 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. Conclusions and Relevance: The results suggest that palliative care was associated with a survival benefit among patients with advanced lung cancer. Palliative care should be considered a complementary approach to disease-modifying therapy in patients with advanced lung cancer.
Importance: Palliative care is a patient-centered approach associated with improvements in quality of life; however, results regarding its association with a survival benefit have been mixed, which may be a factor in its underuse. Objective: To assess whether early palliative care is associated with a survival benefit among patients with advanced lung cancer. Design, Setting, and Participants: This retrospective population-based cohort study was conducted among patients with lung cancer who were diagnosed with cancer between January 1, 2007, and December 31, 2013, with follow-up until January 23, 2017. Participants comprised 23 154 patients with advanced lung cancer (stage IIIB and stage IV) who received care in the Veterans Affairs health care system. Data were analyzed from February 15, 2019, to April 28, 2019. Exposure: Palliative care defined as a specialist-delivered palliative care encounter received after lung cancer diagnosis. Main Outcomes and Measures: The primary outcome was survival. The association between palliative care and place of death was also examined. Propensity score and time-varying covariate methods were used to calculate Cox proportional hazards and to perform regression modeling. Results: Of the 23 154 patients enrolled in the study, 57% received palliative care. The mean (SD) age of participants was 68 (9.5) years, and 98% of participants were men. An 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. Receipt of palliative care was also 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. Conclusions and Relevance: The results suggest that palliative care was associated with a survival benefit among patients with advanced lung cancer. Palliative care should be considered a complementary approach to disease-modifying therapy in patients with advanced lung cancer.
Authors: Kenneth Jung; Sehj Kashyap; Anand Avati; Stephanie Harman; Heather Shaw; Ron Li; Margaret Smith; Kenny Shum; Jacob Javitz; Yohan Vetteth; Tina Seto; Steven C Bagley; Nigam H Shah Journal: J Am Med Inform Assoc Date: 2021-06-12 Impact factor: 4.497
Authors: F Amos Bailey; Beverly R Williams; Patricia S Goode; Richard E Kennedy; David T Redden; Elizabeth Kvale; Marie Bakitas; J Nicholas Dionne-Odom; Kathryn L Burgio Journal: J Gen Intern Med Date: 2021-02-05 Impact factor: 6.473
Authors: Ayako Matsuda; Kenichi Inoue; Manami Momiyama; Kobayashi Kunihiko; Kaoru Kubota; Soerindra S R S Ramai; Maarten J Fischer; Judith R Kroep; Adrian A Kaptein; Kazue Yamaoka Journal: Asian Pac J Cancer Prev Date: 2022-01-01
Authors: Anna Tavakkoli; B Joseph Elmunzer; Akbar K Waljee; Caitlin C Murphy; Sandi L Pruitt; Hong Zhu; Rong Rong; Richard S Kwon; James M Scheiman; Joel H Rubenstein; Amit G Singal Journal: Gastrointest Endosc Date: 2020-06-09 Impact factor: 9.427