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Can early palliative care for non-small cell lung cancer improve end-of-life outcomes and reduce cost in the real world? A population-based study

Study Lead
Study Lead
Assistant Professor
Timothy Hanna, Assistant Professor, Queen's University Department of Oncology
Deborah Dudgeon, Department of Palliative Care, Queen's University
José Pereira, Department of Palliative Care, Queen's University
Lisa Barbera, Department of Radiation Oncology, Sunnybrook Odette Cancer Centre
Amanda Vandyk, Nursing, University of Ottawa
Craig Goldie, Department of Palliative Care, Queen's University
Yingwei (Paul) Peng, Department of Oncology, Queen's University
Andrew Robinson, Department of Oncology, Queen's University

What? In Canada, lung cancer is the second most commonly diagnosed cancer and the leading cause of cancer-related death. When lung cancer becomes metastatic, or stage IV, the median survival is less than one year. Many people in this stage experience a high symptom burden that compromises their quality of life and results in aggressive end of life care.

Traditionally, palliative care consultation is delivered late in the course of the disease, when it becomes evident that disease modifying treatments are unsuccessful. Recent studies have suggested that palliative care services should be provided earlier in the disease trajectory, close to the diagnosis of life-threating cancer, in order to enhance the quality of end of life care offered to patients. The potential quality of life improvements associated with offering early palliative care, concurrent with standard oncologic care, as well as the economic impact of these new recommendations, remain to be explored in a real world population-based setting.

Why? The goal of this project is to explore quality indicators associated with early palliative care in adults with metastatic non-small-cell lung cancer. Furthermore, we will conduct an economic analysis of the palliative management of non-small cell lung cancer within a Canadian context. This is necessary to support the rationale for future investment in making palliative treatment more accessible.

How? In this study, we will use health administrative data sources in the province of Ontario to 1) Describe end of life outcomes for non-small cell lung cancer patients, 2) Investigate whether early palliative care is associated with improved end of life outcomes and survival 3) Investigate whether early palliative care of associated with reduced costs of care  

Results: Dr. Goldie and her collaborators recently completed a retrospective cohort study of patients who were diagnosed with NSCLC and died in Ontario, Canada from 2009-2017. Indicators of aggressive care were present in 50.3% of the cohort and indicators for supportive care were present in 60.3% (n=37,203). The number of patients who received aggressive care decreased over the 2009-2017 study period (57% to 45%) while those receiving supportive care increased (54% to 68%). Male sex and increased comorbidity were associated with more aggressive end of life care and less supportive care. Older age had a negative association and rurality had a positive association with aggressive care. Finally, 56.0% of the cohort did not have access to palliative care consultation before death. Continuing efforts need to be made to improve the quality of end of life care for advanced NSCLC as our results demonstrate that proposed Canadian benchmarks were not met and practice improvement is necessary.

Impact of findings: Advancing our understanding of outcomes associated with early palliative care is important for improving generalizability; results may inform how services and funding are delivered at the population level, by defining whether early palliative care shows benefit in routine practice. Application of findings also have the potential to reduce some of the stigma attached to early palliative care referral, through highlighting its benefits, including a potential survival benefit. Our project is undertaken with an integrated knowledge translation framework, to ensure research is successfully translated into practice. We anticipate that our results will be informative to this emerging field and form a platform for further inquiry and collaboration among the research team

Funded By
CIHR - Secondary Data Analysis for Cancer Prevention and Control