The Impact of Early Palliative Care on Survival for Individuals with Advanced Non-Small Cell Lung Cancer
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Authors
Rodericks, Meaghan
Date
2025-01-09
Type
thesis
Language
eng
Keyword
non-small cell lung cancer , early palliative care , survival , symptom burden , patient-reported outcomes
Alternative Title
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.
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This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NoDerivatives 4.0 International
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NoDerivatives 4.0 International