Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer

Abstract

Background Patients with metastatic non–small-cell lung cancer have a substantial symptom burden and may receive aggressive care at the end of life. We examined the effect of introducing palliative care early after diagnosis on patient-reported outcomes and end-of-life care among ambulatory patients with newly diagnosed disease. Methods We randomly assigned patients with newly diagnosed metastatic non–small-cell lung cancer to receive either early palliative care integrated with standard onco- logic care or standard oncologic care alone. Quality of life and mood were assessed at baseline and at 12 weeks with the use of the Functional Assessment of Cancer Therapy–Lung (FACT-L) scale and the Hospital Anxiety and Depression Scale, re- spectively. The primary outcome was the change in the quality of life at 12 weeks. Data on end-of-life care were collected from electronic medical records. From Massachusetts General Hospital, Boston (J.S.T., J.A.G., A.M., E.R.G., V.A.J., C.M.D., J.J., W.F.P., J.A.B.); the State Uni- versity of New York, Buffalo (S.A.); Adult Palliative Medicine, Department of Anes- thesiology, Columbia University Medical Center, New York (C.D.B.); and Yale Uni- versity, New Haven, CT (T.J.L.). Address reprint requests to Dr. Temel at Massa- chusetts General Hospital, 55 Fruit St., Yawkey 7B, Boston, MA 02114, or at jtemel@partners.org. N Engl J Med 2010;363:733-42. Copyright © 2010 Massachusetts Medical Society. Results Of the 151 patients who underwent randomization, 27 died by 12 weeks and 107 (86% of the remaining patients) completed assessments.