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. 2024 Sep 11;332(14):1153-1164.
doi: 10.1001/jama.2024.13964. Online ahead of print.

Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer: A Multisite Randomized Clinical Trial

Joseph A Greer  1   2 , Jennifer S Temel  2   3 , Areej El-Jawahri  2   3 , Simone Rinaldi  3 , Mihir Kamdar  2   3 , Elyse R Park  1   2   3 , Nora K Horick  3 , Kedie Pintro  3 , Dustin J Rabideau  2   3 , Lee Schwamm  4 , Josephine Feliciano  5 , Isaac Chua  6   7 , Konstantinos Leventakos  8 , Stacy M Fischer  9 , Toby C Campbell  10 , Michael W Rabow  11 , Finly Zachariah  12 , Laura C Hanson  13 , Sara F Martin  14 , Maria Silveira  15   16 , Laura Shoemaker  17 , Marie Bakitas  18 , Jessica Bauman  19 , Lori Spoozak  20 , Carl Grey  21 , Leslie Blackhall  22 , Kimberly Curseen  23 , Sean O'Mahony  24 , Melanie M Smith  25 , Ramona Rhodes  26 , Amelia Cullinan  27 , Vicki Jackson  2   3 ; REACH PC Investigators
Collaborators, Affiliations

Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer: A Multisite Randomized Clinical Trial

Joseph A Greer et al. JAMA. .

Erratum in

  • Error in Table 2.
    [No authors listed] [No authors listed] JAMA. 2025 May 6;333(17):1549. doi: 10.1001/jama.2025.5571. JAMA. 2025. PMID: 40208605 Free PMC article. No abstract available.

Abstract

Importance: Numerous studies show that early palliative care improves quality of life and other key outcomes in patients with advanced cancer and their caregivers, although most lack access to this evidence-based model of care.

Objective: To evaluate whether delivering early palliative care via secure video vs in-person visits has an equivalent effect on quality of life in patients with advanced non-small cell lung cancer (NSCLC).

Design, setting, and participants: Randomized, multisite, comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 US cancer centers among 1250 patients within 12 weeks of diagnosis of advanced NSCLC and 548 caregivers.

Intervention: Participants were randomized to meet with a specialty-trained palliative care clinician every 4 weeks either via video visit or in person in the outpatient clinic from the time of enrollment and throughout the course of disease. The video visit group had an initial in-person visit to establish rapport, followed by subsequent virtual visits.

Main outcomes and measures: Equivalence of the effect of video visit vs in-person early palliative care on quality of life at week 24 per the Functional Assessment of Cancer Therapy-Lung questionnaire (equivalence margin of ±4 points; score range: 0-136, with higher scores indicating better quality of life). Participants completed study questionnaires at enrollment and at weeks 12, 24, 36, and 48.

Results: By 24 weeks, participants (mean age, 65.5 years; 54.0% women; 82.7% White) had a mean of 4.7 (video) and 4.9 (in-person) early palliative care encounters. Patient-reported quality-of-life scores were equivalent between groups (video mean, 99.7 vs in-person mean, 97.7; difference, 2.0 [90% CI, 0.1-3.9]; P = .04 for equivalence). Rate of caregiver participation in visits was lower for video vs in-person early palliative care (36.6% vs 49.7%; P < .001). Study groups did not differ in caregiver quality of life, patient coping, or patient and caregiver satisfaction with care, mood symptoms, or prognostic perceptions.

Conclusions and relevance: The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC, underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery.

Trial registration: ClinicalTrials.gov Identifier: NCT03375489.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Greer reported receiving personal fees for consulting from BeiGene; for serving as a member of the speakers bureau from GlaxoSmithKline (GSK); royalties from Oxford University Press; and research funding from Blue Note Therapeutics outside the submitted work. Dr El-Jawahri reported receiving personal fees for consulting from Incyte Corporation, GSK, and Tuesday Health outside the submitted work. Dr Kamdar reported receiving personal fees from Tuesday Health outside the submitted work. Dr Schwamm reported receiving grants from the National Institute of Neurological Disorders and Stroke (The Impact of Telestroke on Patterns of Care and Long-Term Outcomes, R01NS111952) and the Risk Management Foundation of the Harvard Medical Institutions (Advancing Digital and Virtual Opportunities for Care Access Translates to Equity, 2020A019334) outside the submitted work; and serving on the editorial board and as the digital health section editor for Stroke. Dr Feliciano reported receiving personal fees from AstraZeneca, Regeneron, Coherus, Eli Lilly, and Genentech; and grants from Bristol Myers Squibb and Pfizer outside the submitted work. Dr Leventakos reported consulting for Amgen; and honoraria to institution from Boehringer Ingelheim for consulting; from AstraZeneca, Janssen, Jazz Pharmaceuticals, Mirati Therapeutics, Regeneron, Takeda, and Targeted Oncology for serving on their advisory boards; from OncLive State of the Science Summit, MJH Life Sciences, and Targeted Oncology for CME presentations; and grants from AstraZeneca and Mirati Therapeutics for research support to institution outside the submitted work. Dr Fischer reported receiving grants from Patient-Centered Outcomes Research Institute (PCORI) during the conduct of the study. Dr Zachariah reported receiving personal fees from Empower Hope, Inc for serving as chief medical officer/shareholder; and personal fees from Premier and Healthcare Infusion Services for serving as an advisor outside the submitted work. Dr Bauman reported receiving personal fees from Mirati Therapeutics, Pfizer, and EMD Serono for serving on their advisory boards outside the submitted work. Dr Rhodes reported receiving grants from PCORI during the conduct of the study. Dr Jackson reported receiving personal fees from Tuesday Health for consulting and serving as co-chair of the clinical advisory board outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Recruitment, Randomization, and Follow-Up
FACT-L indicates Functional Assessment of Cancer Therapy-Lung (see Table 1 footnotes for score range and interpretation).
Figure 2.
Figure 2.. Changes in Patient-Reported Quality of Life From Baseline to Week 24 by Study Group
The parallel line plot contains 1 dot with a vertical line for each participant (ordered by baseline FACT-L score) that extends from their week 0 FACT-L value (dot) to the value at week 24 (end of vertical line). Participants with FACT-L score observed at baseline but missing at week 24 are depicted as a dot without a vertical line. Participants with missing baseline FACT-L score (15 randomized to video visits, 11 randomized to in-person visits) were excluded. Descending vertical lines indicate a worsening in patient-reported quality of life over time; ascending vertical lines indicate an improvement in patient-reported quality of life. Baseline values are placed in ascending order for participants assigned to video visits and descending order for participants assigned to in-person visits. On the box plots, the tops and bottoms of the boxes indicate IQRs; center horizontal lines, medians; and diamonds, means. Whiskers extend to the highest and lowest values within 1.5 times the IQR, and dots reflect more extreme data. FACT-L indicates Functional Assessment of Cancer Therapy-Lung (see Table 1 footnotes for score range and interpretation).
Figure 3.
Figure 3.. Longitudinal Patient-Reported Outcome Measures Up to 24 Weeks by Study Group
The tops and bottoms of the boxes indicate IQRs; center horizontal lines, medians; and diamonds, means. Whiskers extend to the highest and lowest values within 1.5 times the IQR, and dots reflect more extreme data. The numbers beneath the plots show the number of patients in each group who completed the patient-reported assessment. Brief-COPE indicates Coping Orientation to Problems Experienced Inventory; FACT-L, Functional Assessment of Cancer Therapy-Lung; HADS, Hospital Anxiety and Depression Scale; PHQ-9, Patient Health Questionnaire-9 (see Table 1 footnotes for score ranges and interpretation).
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