TY - JOUR
T1 - Association of early palliative care use with survival and place of death among patients with advanced lung cancer receiving care in the veterans health administration
AU - Sullivan, Donald R.
AU - Chan, Benjamin
AU - Lapidus, Jodi A.
AU - Ganzini, Linda
AU - Hansen, Lissi
AU - Carney, Patricia A.
AU - Fromme, Erik K.
AU - Marino, Miguel
AU - Golden, Sara E.
AU - Vranas, Kelly C.
AU - Slatore, Christopher G.
N1 - Funding Information:
outside the submitted work. Dr Fromme reported receiving grants from the Gordon and Betty Moore Foundation, The John A. Hartford Foundation, and The Pew Charitable Trusts, and compensation for coauthorship and presentation of a paper entitled “Serious Illness Workforce Training” at a University of California, San Francisco, summit from the Gordon and Betty Moore Foundation outside the submitted work. No other disclosures were reported.
Funding Information:
Funding/Support: This research was supported by grants K07CA190706 from the National Cancer Institute of the National Institutes of Health (Dr Sullivan); CIN 13-404 from the VA Health Services Research and Development Service, Center to Improve Veteran Involvement in Care, VA Portland Health Care System; and VA HSR RES 13-457 from the United States Department of Veterans Affairs, VA Informatics and Computing Infrastructure. Support for data from the United States Department of Veterans Affairs and the Centers for Medicare & Medicaid Services was provided by the United States Department of Veterans Affairs, VA Health Services Research and Development Service, VA Information Resource Center (Dr Sullivan).
Funding Information:
reported receiving grants from the National Institute of Nursing Research of the National Institutes of Health and airfare and honorarium for an in-person presentation at the 2018 Association of VA Hematology/Oncology Annual Meeting
Publisher Copyright:
© 2019 American Medical Association. All rights reserved.
PY - 2019/12
Y1 - 2019/12
N2 - 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 23154 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 23154 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.
AB - 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 23154 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 23154 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.
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U2 - 10.1001/jamaoncol.2019.3105
DO - 10.1001/jamaoncol.2019.3105
M3 - Article
C2 - 31536133
AN - SCOPUS:85072530176
SN - 2374-2437
VL - 5
SP - 1702
EP - 1709
JO - JAMA oncology
JF - JAMA oncology
IS - 12
ER -