In cancer care, treating tumors is just part of a broader plan. Patients need help managing symptoms of the disease and side effects from treatment. While clinicians recognize the importance of this palliative care, it’s not accessible to all patients. A new study indicates telehealth can provide an alternative to in-person visits with a palliative care clinician.
The study results were presented during the annual meeting of the American Society of Clinical Oncology, held recently in Chicago. While awareness of palliative care is growing, it sometimes gets confused with the end-of-life care in hospice, according to Joseph Greer, co-director of the cancer outcomes programs at Massachusetts General Hospital (MGH) Cancer Center and the study’s lead investigator. Unlike hospice, which does not include any curative treatments, palliative care is offered in parallel to treatment of the disease. It is also offered when patients go off of treatment.
“The palliative care team is here to support you to live as well as possible for as long as possible,” Greer said in a briefing with journalists at the ASCO conference.
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Guidelines of ASCO and other professional organizations recommend integrating palliative care from the time of a diagnosis of advanced cancer. Nevertheless, many patients don’t get this care, Greer said. On the clinician side, there are not enough specially trained palliative care clinicians, he explained. From the patient perspective, living in a rural area or lacking transportation can make it difficult to access such care.
Providing healthcare via telehealth increased during the Covid-19 pandemic, and many clinical facilities have the capability to offer video visits, Greer said. But it has been unclear whether virtual visits are just as effective as in-person visits. The study aimed to answer that question.
A total of 1,250 patients with advanced non-small cell lung cancer were enrolled across 22 cancer centers in the U.S. Participants were randomly assigned to meet with a palliative care clinician every four weeks, either in person or through a video visit. The Patient-Centered Outcomes Research Institute-funded study ran between 2018 and 2023. During the pandemic, 3.9% of the visits for participants in the in-person group were conducted via video. Prior to the pandemic, all sites used a videoconference platform hosted and managed by MGH. After the pandemic, sites were allowed to use their own platforms.
The study’s main goal was to show whether telehealth visits are equivalent to in-person palliative care. The comparison was made with scores on a scale used to assess quality of life in lung cancer patients. Results show that scores at week 24 in the telehealth group were equivalent to scores in the in-person group. The scores did not differ on measures of depression and anxiety symptoms, use of coping skills, or perceptions of the goal of treatment and curability of the cancer. On average, the video visits lasted 30 minutes, compared to 35 minutes for in-person visits. But Greer noted that this difference did not affect patient satisfaction as the two study groups reported no difference on that outcome measure.
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Clinicians who participated in the trial were surveyed about what was discussed during patient visits. The topics were similar, regardless of whether the care was delivered by telehealth or in person, Greer said. Top topics included building and establishing rapport, the relationship with the patient and the family, and symptom management.
Greer, a psychologist at Harvard, said some patients have expressed to him concern that sharing their worries about side effects or symptoms could jeopardize their treatment. He added that patients are grateful to have a separate relationship with a palliative caregiver with whom they can openly discuss these matters.
“That has a profound effect, in a proactive way, to keep people on treatment,” Greer said.
Dr. Charu Aggarwal of the University of Pennsylvania, the ASCO expert asked to comment on the study, said the results show early palliative care can be delivered successfully, effectively, and efficiently via telehealth, improving access for patients who otherwise may not be able to get such care. She added that early integration of palliative care will improve patient quality of life and lead to improvements in survival in patients with advanced lung cancer.
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