Integrated Onco-Palliative Care Associated With Prolonged Survival Compared to Standard Care for Patients With Advanced Lung Cancer: A Retrospective Review.

Abstract

Lung cancer is the leading cause of cancer-related death in the U.S. A large randomized controlled trial in advanced lung cancer found a survival advantage with an early palliative care (EPC) intervention compared to standard oncologic care. We performed retrospective analysis of our partially integrated onco-palliative care lung cancer clinic to evaluate overall survival and resource utilization. All outpatients with advanced lung cancer cared for within our institution from 2007 to 2011 were identified. Overall survival, clinical trial participation, hospice enrollment and length of stay, and chemotherapy utilization were calculated for patients treated with EPC and compared to standard oncologic care. Two hundred seven patients with advanced lung cancer were identified; 82 received EPC. EPC patients had a survival advantage (11.9 vs. 10.1 months, P = 0.031), were more likely to participate in clinical trials (29% vs. 19%, P = 0.014), and median hospice length of stay was longer (38.5 vs. 24 days, P = 0.032). No difference in chemotherapy utilization or hospice enrollment was seen between the groups. EPC in advanced lung cancer was associated with a nearly two-month survival advantage compared to standard oncologic care. This finding provides supportive evidence to previously published reports of survival benefit with EPC intervention. Clinical trial participation rates in advanced lung cancer are lacking, and we found more frequent clinical trial participation in the early PC group. No differences were seen in chemotherapy utilization or hospice enrollment. EPC patients' longer hospice length of stay did not compromise survival.