Does Palliative Care via Telehealth Work in Advanced Cancer?

Does delivering palliative care early via telehealth measure up to in-person care for patients with newly diagnosed advanced lung cancer?

A large randomized trial presented at the American Society of Clinical Oncology (ASCO) annual meeting suggests that it can. 

Researchers found that the benefits of providing palliative care for patients diagnosed with advanced lung cancer are not diminished when delivered via video as opposed to in-person.

“Our findings underscore the potential to increase access to evidence-based early palliative care through telehealth delivery,” lead author Joseph Greer, PhD, with Massachusetts General Hospital and Harvard Medical School in Boston, reported at the meeting.

Guidelines from the ASCO advise integrating palliative care from the time of diagnosis of in the case of advanced cancer. However, most patients and their families do not receive this evidence-based care due to multiple barriers, said Greer.

Greer and colleagues wanted to see if providing palliative care via secure video could be a viable alternative to in-person care.

The REACH PC trial enrolled 1250 patients with newly diagnosed advanced non–small cell lung cancer and 548 of their caregivers from 22 US cancer centers. Study participants were randomly allocated to either monthly video or in-person palliative care visits. 

The patients had a mean age of 65 years, slightly more than half were women, and the majority were non-Hispanic White and married. The two study groups were generally well-balanced with respect to sociodemographic characteristics.

The primary outcome was patient-reported quality of life, assessed via the Functional Assessment of Cancer Therapy–Lung (FACT-L) scale, with higher scores indicating better quality of life (range, 0-136).

On this measure, “we demonstrated the equivalent effect of delivering early palliative care via video versus in-person visits,” Greer reported. At 24 weeks, adjusted mean FACT-L scores were 99.7 in the video group and 97.7 in the in-person group — a two-point difference (P=.04 for equivalence). 

Patients and caregivers gave telehealth and in-person palliative care almost identical satisfaction ratings. The two groups also did not differ in patient-reported anxiety and depression symptoms.

Caregiver attendance was higher in the in-person (49.7%) vs the video-visit group (36.6%) probably because family members or friends often need to accompany patients to appointments. 

“These findings add critical evidence to support ongoing access to telehealth services, especially for vulnerable populations with serious illness, and will ideally inform policy decisions regarding coverage of virtual care in the future,” Greer said. 

ASCO expert Charu Aggarwal, MD, MPH, who was not involved in the research, commented that the trial shows that early palliative care can be delivered “successfully, effectively, and efficiently using telehealth in patients with advanced lung cancer.” 

Findings from this study “underscore the importance of telehealth in improving access and broad dissemination of palliative care for patients who otherwise may not be able to get it,” added Aggarwal, associate professor for lung cancer excellence, University of Pennsylvania, Philadelphia.

Funding for the study was provided by the Patient-Centered Outcomes Research Institute and the National Institute of Nursing Research of the National Institutes of Health. 

Greer and Aggarwal have no relevant disclosures. 

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