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Phase II Study: Integrated Palliative Care in Newly Diagnosed Advanced Non–Small-Cell Lung Cancer Patients

Jennifer S. Temel, Vicki A. Jackson, J. Andrew Billings, Constance Dahlin, Susan D. Block, Mary K. Buss, Patricia Ostler, Panos Fidias, Alona Muzikansky, Joseph A. Greer, William F. Pirl, Thomas J. Lynch

From the Massachusetts General Hospital; and the Dana-Farber Cancer Institute, Boston, MA

Address reprint requests to Jennifer S. Temel, MD, Massachusetts General Hospital, Yawkey 7B, 55 Fruit St, Boston, MA 02114; e-mail: jtemel{at}partners.org

Purpose: To assess the feasibility of early palliative care in the ambulatory setting in patients with newly diagnosed advanced non–small-cell lung cancer (NSCLC).

Patients and Methods: Patients were eligible if they had a performance status of 0 to 1 and were within 8 weeks of diagnosis of advanced NSCLC. Participants received integrated care from oncology and palliative care throughout the course of their disease. Participants were scheduled to meet with the palliative care team (PCT) and complete quality-of–life (QOL) and mood questionnaires monthly for 6 months. The study was deemed feasible if 64% of patients completed at least 50% of their scheduled visits and QOL assessments.

Results: Fifty-one patients were enrolled onto the trial. One died within 72 hours and was not assessable. Ninety percent (95% CI, 0.78 to 0.96) of study participants complied with at least 50% of the palliative care visits. Eight-six percent (95% CI, 0.73 to 0.94) of the participants met the full feasibility requirements by both meeting with the PCT and completing QOL assessments at least 50% of the time. QOL and mood analyses confirmed the high symptom burden in patients with newly diagnosed advanced NSCLC. At least 50% of participants experienced some degree of shortness of breath, cough, difficulty breathing, appetite loss, weight loss, or unclear thinking at their baseline assessment. More than one third of patients had a probable mood disorder at baseline.

Conclusion: Integrated palliative and oncology care is feasible in ambulatory patients with advanced NSCLC.

Supported by an investigator-initiated research grant from Amgen (J.S.T.).

Presented in part at the 41st Annual Meeting of the American Society of Clinical Oncology, Orlando, FL, May 13-17, 2005, and the 11th World Lung Cancer Conference, Barcelona, Spain, July 3-6, 2005.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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