Lung cancer is the second most common cancer treated within VA and is the leading cause of cancer related death among Veterans. Lung cancer is of particular interest within VA because of the high prevalence of current and past tobacco consumption. Palliative care improves the quality of life of patients for problems associated with life-limiting illness through the prevention and relief of suffering by early identification, assessment, and treatment of pain and other physical symptoms including psychological and spiritual needs. The conceptual tenets of palliative care services are concordant with providing Veterans personalized proactive, patient-driven health care and achieve measurable improvements in health outcomes.
Despite guideline recommendations to integrate palliative care into curative care, the majority of patients do not receive palliative care services until all curative options are exhausted. Initiating early palliative care shortly after lung cancer diagnosis may provide an opportunity to improve this aspect of care.
The objective of the study is to test a nurse-led telephone-based palliative care intervention on improving the delivery of care for patients with newly diagnosed lung cancer. Our pilot data demonstrated the intervention is feasible to conduct and is acceptable to patients. The study is a three-site randomized control trial to determine the efficacy of the intervention on improving patients' quality of life, symptom burden, and satisfaction of care. Additionally, the study will test an innovative care delivery model to improve patients' access to palliative care. This intervention will focus on patients across the spectrum of stages of disease. We will also determine the effect of the intervention on patient activation to discuss treatment preferences with their clinician and on clinician knowledge of patients' goals of care.
Recruitment activities are targeted to identify lung cancer patients at the Puget Sound Health Care System, the Birmingham VA, and the Portland VA who will receive therapy other than solely surgical resection. Virtually all patients undergoing evaluation for lung cancer at the both VAs are presented at the Tumor Board, or are evaluated in the chest (thoracic surgery and pulmonary), oncology and radiation oncology clinics. The Birmingham VA and the Portland VA evaluates patients being seen in the lung cancer clinic. These patients are screened weekly to determine study eligibility.
Patients meeting entry criteria who consent to study participation and complete a baseline assessment will be randomized to 1) the intervention arm: palliative care plus usual care or the 2) usual care arm. Patients randomized to the intervention arm receive usual oncologic care and phone calls from a nurse. The primary outcome measures are collected at baseline and at the end of the patients' primary cancer treatment and assess quality of life and symptom burden, as measured by the Functional Assessment of Cancer Therapy-Lung (FACT-L) Trial Outcome Index (TOI) survey and patient satisfaction of care, measured by the FAMCARE-13. Secondary outcome measures will determine the effect of the intervention on patient activation to discuss treatment preferences with their clinician, on clinician knowledge of patients' goals of care, and on interdisciplinary resource utilization.
We will recruit individuals (n=138) with lung cancer over 2.5 years. The results of this study will inform a future effectiveness/implementation study.
There are no findings to report at this time. Listed below are the key study aims:
Determine the efficacy of a nurse-led telephone-based intervention that includes early provision of palliative care to improve outcomes for Veterans with newly diagnosed lung cancer.
Aim 1: determine if the provision of palliative care integrated at the time of lung cancer diagnosis improves quality of life and symptom burden.
Aim 2: determine effect of a nurse-led telephone-based palliative care intervention on patient activation to discuss treatment preferences with their clinician
Aim 3: determine the effect of a nurse-led telephone based palliative care intervention on clinician knowledge of patients' goals of care.
Aim 4: determine if the provision of palliative care integrated at time of lung cancer diagnosis improves interdisciplinary resource utilization as compared to a usual care group
Our pilot study demonstrated the intervention is feasible to conduct and is acceptable to patients. The impact of the current study is to show the efficacy of the nursing intervention on improving patients' quality of life, symptom burden, and satisfaction of care. Additionally, the study will test an innovative nurse lead care delivery model to improve patients' access to palliative care. The nurse, serving as a liaison among palliative care, oncology and other subspecialty services, may reduce barriers to further integration of these services. This would also further support the VA Blueprint of Excellence by providing personalized, proactive, patient-driven health care and improving access and health outcomes.
- Sullivan DR, Slatore CG. Association of Early Palliative Care With Survival in Patients With Advanced Lung Cancer-Reply. JAMA oncology. 2020 Mar 1; 6(3):443-444.
- Sullivan DR, Chan B, Lapidus JA, Ganzini L, Hansen L, Carney PA, Fromme EK, Marino M, Golden SE, Vranas KC, Slatore CG. 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 oncology. 2019 Sep 19.
- Reinke LF, Vig EK, Tartaglione EV, Backhus LM, Gunnink E, Au DH. Protocol and pilot testing: The feasibility and acceptability of a nurse-led telephone-based palliative care intervention for patients newly diagnosed with lung cancer. Contemporary clinical trials. 2018 Jan 1; 64:30-34.
- Reinke LF, Meier DE. Research Priorities in Subspecialty Palliative Care: Policy Initiatives. Journal of palliative medicine. 2017 Aug 1; 20(8):813-820.
- Aslakson RA, Reinke LF, Cox C, Kross EK, Benzo RP, Curtis JR. Developing a Research Agenda for Integrating Palliative Care into Critical Care and Pulmonary Practice To Improve Patient and Family Outcomes. Journal of palliative medicine. 2017 Apr 1; 20(4):329-343.
HSR&D or QUERI Publications
- Reinke LF. Palliative Care Intervention for Newly Diagnosed VA Outpatients with Lung Cancer. 2018 Feb 1; 7(7).