Age and Gender Moderate the Impact of Early Palliative Care in Metastatic Non-Small Cell Lung Cancer

Abstract

Background: Studies demonstrate that early palliative care (EPC) improves advanced cancer patients' quality of life (QOL) and mood. However, it remains unclear whether the role of palliative care differs based upon patients' demographic characteristics. We explored whether age and gender moderate the improvements in QOL and mood seen with EPC.

Methods: We performed a secondary analysis of data from a randomized controlled trial of patients with metastatic non-small cell lung cancer. Patients received either EPC integrated with oncology care or oncology care alone. We assessed the degree to which QOL (Trial Outcome Index [TOI]) and mood (Hospital Anxiety and Depression Scale [HADS] and Patient Health Questionnaire 9 [PHQ-9]) outcomes at week 12 varied by patient age (<65) and gender. The week 12 data of 107 patients are included in this analysis.

Results: At 12 weeks, younger patients receiving EPC reported better QOL (TOI mean = 62.04 vs. 49.43, p = .001) and lower rates of depression (HADS-Depression = 4.0% vs. 52.4%, p < .001; PHQ-9 = 0.0% vs. 28.6%, p = .006) than younger patients receiving oncology care alone. Males receiving EPC reported better QOL (TOI mean = 58.81 vs. 48.30, p = .001) and lower rates of depression (HADS-Depression = 18.5% vs. 60.9%, p = .002; PHQ-9 = 3.8% vs. 34.8%, p = .008) than males receiving oncology care alone. At 12 weeks, QOL and mood did not differ between study groups for females and older patients.

Conclusion: Males and younger patients who received EPC had better QOL and mood than those who received oncology care alone. However, these outcomes did not differ significantly between treatment groups for females or older patients.

Implications for practice: This study found that early palliative care improves patients' quality of life and mood differentially based on their age and gender. Specifically, males and younger patients receiving early palliative care experienced better quality of life and mood than those receiving oncology care alone. Conversely, females and older patients did not experience this treatment effect. Thus, palliative care interventions may need to be tailored to patients' age- and gender-specific care needs. Studying how patients' demographic characteristics affect their experience with palliative care will enable the development of interventions targeted to the distinct supportive care needs of patients with cancer.

Keywords: Advanced cancer; Gender; Geriatrics; Mood; Palliative care; Quality of life.

Figure 1.

Quality-of-life scores from baseline to week 12 stratified by age. Using TOI scores, participants’ quality-of-life from baseline to week 12 are shown for age <65 (A) and age ≥65 (B). Abbreviation: TOI, Trial Outcome Index.

Figure 2.

Week 12 depressive symptoms stratified by age. Stratified by age <65, week 12 depressive symptoms across study arms are shown according to the HADS depression subscale (A) and the PHQ-9 (B). Abbreviations: HADS, Hospital Anxiety and Depression Scale; PHQ-9, Patient Health Questionnaire 9.

Figure 3.

Quality-of-life scores from baseline to week 12 stratified by gender. Using TOI scores, participants’ quality-of-life from baseline to week 12 are shown for male patients (A) and female patients (B). Abbreviation: TOI, Trial Outcome Index.

Figure 4.

Week 12 depressive symptoms stratified by gender. Stratified by gender, participants’ week 12 depressive symptoms across study arms are shown according to the HADS depression subscale (A) and the PHQ-9 (B). Abbreviations: HADS, Hospital Anxiety and Depression Scale; PHQ-9, Patient Health Questionnaire 9.