KEY TAKEAWAYS
- The REACH PC study aimed to compare EPC via video vs. in-person for patients and caregivers with advanced NSCLC.
- Researchers concluded that Telehealth offers equivalent effectiveness to in-person visits for early palliative care, suggesting wider accessibility.
National guidelines recommend the early integration of palliative and oncology care for patients with advanced cancer due to its proven benefits for quality of life (QOL) and other outcomes. However, limited access and resources often hinder early palliative care (EPC) delivery in outpatient settings. To address these challenges, we conducted a comprehensive comparative effectiveness trial comparing EPC delivery via secure video versus in-person visits among patients with advanced non-small cell lung cancer (NSCLC) and their caregivers.
Joseph A. Greer and the team aimed to assess the effectiveness of telehealth-delivered EPC compared to traditional in-person visits.
They conducted an inclusive analysis between 6/14/2018 and 5/4/2023, enrolling 1250 patients with advanced NSCLC diagnosed within the past 12 weeks. The study was a randomized trial comparing telehealth versus in-person EPC across 22 cancer centers in the US. Patients were assigned randomly to meet with a palliative care clinician every 4 weeks, either via video or in the outpatient clinic. Self-report measures were completed at baseline and weeks 12 and 24.
The primary aim was to assess the equivalence of telehealth versus in-person EPC on QOL at week 24, using regression modeling with an equivalence margin of ±4 points on the Functional Assessment of Cancer Therapy-Lung (FACT-L, range = 0-136). Additional comparisons included rates of caregiver participation in EPC visits and patient-reported depression and anxiety symptoms (Patient Health Questionnaire-9; Hospital Anxiety and Depression Scale), coping (Brief COPE), and perceptions of prognosis (Perceptions of Treatment and Prognosis Questionnaire) between groups. Study recruitment ceased for two months at the onset of the COVID-19 pandemic.
Participants with a mean age of 65.5 years (54.0% female; 82.1% White) had a mean of 4.75 and 4.92 palliative care encounters by week 24 in the telehealth and in-person groups, respectively. Due to the pandemic, 3.9% of in-person visits occurred via video. QOL scores at week 24 for patients in the telehealth group equaled those in the in-person EPC group (adjusted means: 99.67 versus 97.67, P < 0.043 for equivalence). Caregiver participation in EPC visits was lower in the telehealth versus in-person group (36.6% versus 49.7%, P < 0.0001). Study groups did not differ in depression and anxiety symptoms, use of coping skills, or perceptions of the goal of treatment and curability of their cancer.
The study concluded that delivery of EPC via video versus in-person visits showed comparable effects on QOL among patients with advanced NSCLC. Both modalities demonstrated no significant differences across various patient-reported outcomes, although caregivers participated more in in-person visits. These findings highlight the significant potential for expanding access to and wider adoption of telehealth-based EPC, thus enhancing the dissemination of this evidence-based care model.
The trial was sponsored by the Massachusetts General Hospital.
Source: https://meetings.asco.org/abstracts-presentations/237865
Clinical Trial: https://clinicaltrials.gov/study/NCT03375489
Greer J.A., Trotter C, Jackson V, et al. (2024). “Comparative effectiveness trial of early palliative care delivered via telehealth versus in person among patients with advanced lung cancer.” Presented at ASCO 2024. J Clin Oncol 42, 2024 (suppl 17; abstr LBA3), 10.1200/JCO.2024.42.17_suppl.LBA3
