The treatment management of non-small cell lung cancer has improved significantly in recent years. Innovative treatment options point the way to personalized therapy with fewer side effects and an improved prognosis. In addition, the care structures for seriously ill or elderly patients must not be ignored. Because even there, small supportive measures can lead to a better quality of life.
National guidelines recommend the early integration of palliative and oncology care for patients with advanced cancer. There is solid evidence that this model of care improves quality of life and other important outcomes. However, most patients do not receive early palliative care (EPC) in the outpatient setting due to limited access and resources. To overcome these barriers, a large-scale comparative effectiveness trial of EPC delivered via secure video versus face-to-face care was conducted among patients with advanced non-small cell lung cancer (NSCLC) and their caregivers [1]. For this purpose, 1250 NSCLC patients were randomized. They were randomly selected to meet with a palliative care physician every four weeks from admission until the disease progressed, either by video or in the outpatient clinic. The participants completed self-report forms at the start of the study and in weeks 12 and 24. The primary objective was to assess the equivalence of the effect of telemedicine versus in-person EPC on quality of life at week 24. In addition, caregiver participation in EPC visits and patients’ reported depression and anxiety symptoms, coping and perception of prognosis were compared between the groups. It was found that conducting EPC via video had an equivalent impact on quality of life compared to face-to-face visits. The two modalities also did not differ in terms of a number of patient-reported outcomes, although caregivers completed more face-to-face visits than video visits. The results underline the considerable potential for improving access to this evidence-based care model and its further dissemination through telemedicine care.
Optimized treatment management of elderly patients
To determine the optimal treatment for elderly cancer patients, it is recommended that a geriatric assessment (GA) be performed prior to chemotherapy. In the ENSURE-GA study, which focused on patients with non-small cell lung cancer (NSCLC) aged 75 years and older, it was reported that performing GA not only improved patient satisfaction in terms of communication with their physicians, but also improved patients’ quality of life [2]. In addition, it was investigated whether GA could improve overall survival and serve as a predictor of serious adverse events. The study included 1021 patients aged ≥75 years with NSCLC who were unable to undergo radical treatment. All patients underwent a standardized GA prior to treatment. The participating facilities were randomly divided into an intervention group and a control group. In the intervention group, clinicians were provided with GA summaries and recommendations for GA-guided interventions to assist them in selecting treatments and interventions. In the control group, no GA summaries were provided to the physicians. No significant differences in patient characteristics or GA domains were found between intervention and control groups. In addition, there were no significant differences in 1-year overall survival or in the occurrence of grade 3 or higher adverse events in patients receiving medical treatment. However, the implementation of the GA and the measures based on its results increased patient satisfaction.
Congress: American Society of Clinical Oncology (ASCO) 2024
Literature:
- Greer JA, et al: Comparative effectiveness trial of early palliative care delivered via telehealth versus in person among patients with advanced lung cancer. J Clin Oncol 2024; 42(suppl 17): abstr LBA3.
- Furuya N, et al: Geriatric assessment in older patients with non-small cell lung cancer: Insights from a cluster-randomized, phase III trial – ENSURE-GA study (NEJ041/CS-Lung001). J Clin Oncol 2024; 42(suppl 17): abstr 1502.
InFo ONKOLOGIE & HÄMATOLOGIE 2024; 12(3): 22 (published on 3.7.24, ahead of print)
