The Impact of Early Palliative Care on Survival for Individuals with Advanced Non-Small Cell Lung Cancer
Year: 2025
Type: dissertation
Study design: Observational Study
Abstract: Background: Patients with advanced non-small cell lung cancer (NSCLC) face a high symptom burden and poor prognosis. While previous studies suggest early palliative care (EPC) improves quality of life, reduces symptom burden and hospital use, and extends survival for advanced NSCLC patients, there is limited evidence on the real-world impact of EPC on survival for these patients. Objective: This study investigated the association between EPC at the time of advanced NSCLC diagnosis and overall survival, accounting for patient-reported symptom burden. Methods: We conducted a retrospective, population-based cohort study using ICES data. Patients receiving palliative intent anticancer treatment and who had a symptom burden score within 8 weeks of diagnosis were included. EPC was defined by receipt of specialist palliative care consultation within 8 weeks of first palliative intent anticancer treatment. Baseline characteristics were summarized, and patients were stratified by symptom burden (low, moderate, high). Propensity score matching was used to compare those who received EPC with those who received late palliative care or no palliative care. Kaplan-Meier curves and multivariate Cox regression were applied to evaluate the impact of EPC on survival. Results: A total of 1,720 patients were matched on baseline characteristics. Contrary to our hypothesis, those who received EPC had lower survival within the first 4 years. Survival rates were 21.74% vs. 40.58% at 1 year, 8.88% vs. 21.71% at 3 years, and 4.13% vs. 10.41% at 4 years (P < .001). Multivariable Cox regression showed EPC was associated with decreased survival (HR: 1.59, 95% CI 1.48-1.71), consistent across symptom burden groups. Poisson regression analyses revealed that patients with worse patient-reported functional status and symptom burden were more likely to receive EPC. Receipt of EPC also varied based on year of diagnosis, region, rurality, type of first palliative intent anticancer treatment, and number of emergency department visits. Conclusion: Patients receiving EPC had worse survival, likely because EPC was prioritized for those nearing end of life, suggesting it was responsive rather than proactive EPC. This highlights the need for ii timely integration of EPC to maximize its potential benefit on both quality of life and survival in advanced NSCLC patients.
Author: Rodericks, Meaghan
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7029101216