Association of Patient-Centered Elements of Care and Palliative Care Among Patients With Advanced Lung Cancer

Abstract

Context

Palliative care (PC) is associated with improved quality of life, survival, and decreased healthcare use at the end of life among lung cancer patients. However, the specific elements of palliative care that may contribute to these benefits are unclear.

Objectives

To evaluate the associations of PC and its setting of delivery with prescriptions of symptom management medications, advance care planning (ACP), hospice enrollment, and home health care (HHC) receipt.

Methods

Retrospective, cohort study of patients with advanced stage (IIIB/IV) lung cancer in the Veterans Health Administration (VA) diagnosed from 2007-2013; with follow-up through 2017. Propensity score methods were used with inverse probability of treatment weighting and logistic regression modeling, adjusting for patient and tumor characteristics.

Results

Among 23 142 patients, 57% received PC. Compared to non-receipt of PC, PC in any setting (inpatient or outpatient) was associated with increased prescriptions of pain medications (Adjusted Odds Ratio (aOR) = 1.63, 95% CI: 1.45-1.83), constipation regimen with pain medications (aOR = 2.04, 95% CI: 1.63-2.54), and antidepressants (aOR = 1.78, 95% CI: 1.52-2.09). PC was also associated with increased ACP (aOR = 1.52, 95% CI: 1.37-1.67) and hospice enrollment (aOR = 1.39, 95% CI:1.31-1.47), and decreased HHC (aOR = 0.79, 95% CI: 0.70-.90) compared to non-receipt of PC. Receipt of PC in outpatient settings was associated with increased prescriptions of pain medications (aOR = 2.54, 95% CI: 2.13-3.04) and antidepressants (aOR = 1.76, 95% CI: 1.46-2.12), and hospice enrollment (aOR = 2.09, 95% CI: 1.90-2.31) compared to receipt of PC in inpatient settings.

Conclusions

PC is associated with increased use of symptom management medications, ACP, and hospice enrollment, especially when delivered in outpatient settings. These elements of care elucidate potential mechanisms for improved outcomes associated with PC and provide a framework for a primary palliative care approach among non-palliative care clinicians.

Keywords

palliative care lung cancer outpatient symptom management advance care planning hospice oncology quality of life

Get full access to this article

View all access options for this article.

References

Kavalieratos

Corbelli

Zhang

, et al. Association between palliative care and patient and caregiver outcomes: a systematic review and meta-analysis. JAMA. 2016;316(20):2104. doi:10.1001/jama.2016.16840.

Temel

Greer

El-Jawahri

, et al. Effects of early integrated palliative care in patients with lung and gi cancer: a randomized clinical trial. J Clin Oncol. 2017;35(8):834-841. doi:10.1200/JCO.2016.70.5046.

Bakitas

Tosteson

, et al. Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol. 2015;33(13):1438-1445. doi:10.1200/JCO.2014.58.6362.

Dionne-Odom

Azuero

Lyons

, et al. Benefits of early versus delayed palliative care to informal family caregivers of patients with advanced cancer: outcomes from the ENABLE III randomized controlled trial. J Clin Oncol. 2015;33(13):1446-1452. doi:10.1200/JCO.2014.58.7824.

Sung

Patel

Djalalov

, et al. Evolution of symptom burden of advanced lung cancer over a decade. Clin Lung Cancer. 2017;18(3):274-280.e6. doi:10.1016/j.cllc.2016.12.010.

Hechtner

Eichler

Wehler

, et al. Quality of life in nsclc survivors — a multicenter cross-sectional study. J Thorac Oncol. 2019;14(3):420-435. doi:10.1016/j.jtho.2018.11.019.

Sugimura

Yang

. Long-term survivorship in lung cancer. Chest. 2006;129(4):1088-1097. doi:10.1378/chest.129.4.1088.

Sullivan

Chan

Lapidus

, et al. 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. JAMA Oncol. 2019;5(12):1702. doi:10.1001/jamaoncol.2019.3105.

Vranas

Lapidus

Ganzini

Slatore

Sullivan

. Association of palliative care use and setting with health-care utilization and quality of care at the end of life among patients with advanced lung cancer. Chest. 2020;158(6):2667-2674. doi:10.1016/j.chest.2020.06.018.

10.

Ferrell

Temel

Temin

, et al. Integration of palliative care into standard oncology care: American society of clinical oncology clinical practice guideline update. J Clin Oncol. 2017;35(1):96-112. doi:10.1200/JCO.2016.70.1474.

11.

Hui

. Availability and integration of palliative care at US cancer centers. JAMA. 2010;303(11):1054. doi:10.1001/jama.2010.258.

12.

Kamal

Bull

Swetz

Wolf

Shanafelt

Myers

. Future of the palliative care workforce: Preview to an impending crisis. Am J Med. 2017;130(2):113-114. doi:10.1016/j.amjmed.2016.08.046.

13.

Temel

Greer

Muzikansky

, et al. Early palliative care for patients with metastatic non–small-cell lung cancer. N Engl J Med. 2010;363(8):733-742. doi:10.1056/NEJMoa1000678.

14.

Hoerger

Greer

Jackson

, et al. Defining the elements of early palliative care that are associated with patient-reported outcomes and the delivery of end-of-life care. J Clin Oncol. 2018;36(11):1096-1102. doi:10.1200/JCO.2017.75.6676.

15.

Commission-on-cancer . Cancer program standards. Chicago, IL: American College of Surgeons; 2015. American College of Surgeons. Accessed May 18, 2020.

16.

Zullig

Sims

McNeil

, et al. Cancer incidence among patients of the U.S. Veterans Affairs health care system: 2010 update. Mil Med. 2017;182(7):e1883-e1891. doi:10.7205/MILMED-D-16-00371.

17.

Kiley

Ast

, et al. Measuring what Matters: top-ranked quality Indicators for hospice and palliative care from the American academy of hospice and palliative medicine and hospice and palliative nurses association. J Pain Symptom Manag. 2015;49(4):773-781. doi:10.1016/j.jpainsymman.2015.01.012.

18.

National Quality

Forum.

Palliative and End-of-Life Care 2015-2016. Department of Health and Human Services, Washington, DC. https://www.qualityforum.org/Publications/2012/04/Palliative_Care_and_End-of-Life_Care%E2%80%94A_Consensus_Report.aspx. Accessed May 26, 2020.

19.

VA National Formulary - Pharmacy Benefits Management Services . https://www.pbm.va.gov/PBM/NationalFormulary.asp. https://www.pbm.va.gov/PBM/NationalFormulary.asp. Accessed May 25, 2020.

20.

Advance care planning - geriatrics and extended care. Accessed May 25, 2020.https://www.va.gov/GERIATRICS/pages/advance_care_planning_topics.asp.

21.

Sullivan

Ganzini

Lapidus

, et al. Improvements in hospice utilization among patients with advanced-stage lung cancer in an integrated health care system. Cancer. 2018;124(2):426-433. doi:10.1002/cncr.31047.

22.

Deyo

Cherkin

Ciol

. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613-619. doi:10.1016/0895-4356(92)90133-8.

23.

Groll

Bombardier

Wright

. The development of a comorbidity index with physical function as the outcome. J Clin Epidemiol. 2005;58(6):595-602. doi:10.1016/j.jclinepi.2004.10.018.

24.

Sohn

Arnold

Maynard

Hynes

. Accuracy and completeness of mortality data in the department of Veterans Affairs. Popul Health Metrics. 2006;4(1):2. doi:10.1186/1478-7954-4-2.

25.

Rubin

. Matched Sampling for Causal Effects. New York, NY: Cambridge University Press; 2006.

26.

Rubin

. The design versus the analysis of observational studies for causal effects: parallels with the design of randomized trials. 2006:17.

27.

Yang

Cheville

Wampfler

, et al. Quality of life and symptom burden among long-term lung cancer survivors. J Thorac Oncol. 2012;7(1):64-70. doi:10.1097/JTO.0b013e3182397b3e.

28.

Polanski

Jankowska-Polanska

Rosinczuk

Chabowski

Szymanska-Chabowska

. Quality of life of patients with lung cancer. OncoTargets Ther. 2016;9:1023-1028. doi:10.2147/OTT.S100685.

29.

Lou

VWQ

Chen

Jian

, et al. Respiratory symptoms, sleep, and quality of life in patients with advanced lung cancer. J Pain Symptom Manag. 2017;53(2):250-256. doi:10.1016/j.jpainsymman.2016.09.006.e1.

30.

Morrison

Novotny

Sloan

, et al. Emotional Problems, quality of life, and symptom burden in patients with lung cancer. Clin Lung Cancer. 2017;18(5):497-503. doi:10.1016/j.cllc.2017.02.008.

31.

Sloan

Zhao

Novotny

, et al. Relationship between deficits in overall quality of life and non–small-cell lung cancer survival. J Clin Oncol. 2012;26. doi:10.1200/JCO.2010.33.4631.

32.

Sullivan

Forsberg

Ganzini

, et al. Longitudinal changes in depression symptoms and survival among patients with lung cancer: a national cohort assessment. J Clin Oncol. 2016. Published online October 3. doi:10.1200/JCO.2016.66.8459.

33.

Braun

Gupta

Staren

. Quality of life assessment as a predictor of survival in non-small cell lung cancer. BMC Cancer. 2011;11:353. doi:10.1186/1471-2407-11-353.

34.

Andersen

DeRubeis

Berman

, et al. Screening, assessment, and care of anxiety and depressive symptoms in adults with cancer: an American society of clinical oncology guideline adaptation. J Clin Oncol. 2014;32(15):1605-1619. doi:10.1200/JCO.2013.52.4611.

35.

Nugent

Slatore

Ganzini

, et al. POLST registration and associated outcomes among Veterans with advanced-stage lung cancer. Am J Hosp Palliat Med. 2019;36(7):564-570. doi:10.1177/1049909118824543.

36.

Lee

Brumback

Sathitratanacheewin

, et al. Association of physician Orders for life-sustaining treatment with ICU admission among patients hospitalized near the end of life. JAMA. 2020;323(10):950-960. doi:10.1001/jama.2019.22523.

37.

Lammers

Slatore

Fromme

Vranas

Sullivan

. Association of early palliative care with chemotherapy intensity in patients with advanced stage lung cancer: a national cohort study. J Thorac Oncol. 2019;14(2):176-183. doi:10.1016/j.jtho.2018.09.029.

38.

Goldwasser

Vinant

Aubry

, et al. Timing of palliative care needs reporting and aggressiveness of care near the end of life in metastatic lung cancer: a national registry-based study. Cancer. 2018;124(14):3044-3051. doi:10.1002/cncr.31536.

39.

Nickolich

El-Jawahri

Temel

LeBlanc

. Discussing the evidence for upstream palliative care in improving outcomes in advanced cancer. Am Soc Clin Oncol Educ Book. 2016;36:e534-e538. doi:10.1200/EDBK_159224.

40.

Center to Advance Palliative Care . America’s care of serious illness: A state-by-state report card on access to palliative care in our nation’s hospitals. 2019. Available at: https://reportcard.capc.org/. (Accessed May 26, 2020).

41.

Kamal

Wolf

Troy

, et al. Policy changes key to Promoting sustainability and growth of the specialty palliative care workforce. Health Aff. 2019;38(6):910-918. doi:10.1377/hlthaff.2019.00018.

42.

Millen

Yap

. Adaptive trial designs: what are multiarm, multistage trials? Arch Dis Child Educ Pract. 2020;105(6):376-378. doi:10.1136/archdischild-2019-317826.

43.

Ford

Norrie

. Pragmatic trials. N Engl J Med. 2016;375(5):454-463. doi:10.1056/NEJMra1510059.

44.

Wiencek

Coyne

. Palliative care delivery models. Semin Oncol Nurs. 2014;30(4):227-233. doi:10.1016/j.soncn.2014.08.004.

45.

Reckrey

Yang

Kinosian

, et al. Receipt of home-based medical care among older beneficiaries enrolled in fee-for-service Medicare. Health Aff. 2020;39(8):1289-1296. doi:10.1377/hlthaff.2019.01537.

46.

Bernacki

Block

. Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med. 2014;174(12):1994-2003. doi:10.1001/jamainternmed.2014.5271.

47.

Brighton

Bristowe

. Communication in palliative care: talking about the end of life, before the end of life. Postgrad Med J. 2016;92(1090):466-470. doi:10.1136/postgradmedj-2015-133368.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.27 MB