Specialist-delivered palliative care may improve survival outcomes in patients with stage IIIB and stage IV advanced lung cancer when started approximately 1 month to 1 year after diagnosis, study results published in JAMA Oncology suggest.

A team of US researchers conducted a retrospective cohort study comprising 23,154 patients with stage IIIB and stage IV advanced lung cancer (mean age, 68 years) who were treated in the Veterans Affairs (VA) healthcare system. Patients were diagnosed with cancer between 2007 and 2013 and had follow-up data until January 2017. Patients who received palliative care (n=13,109) vs patients who did not receive palliative care (n=10,045) were compared in terms of all-cause mortality and place of death (ie, acute care vs nonacute setting).

Early initiation of palliative care, defined as palliative care started 0 to 30 days after cancer diagnosis, was associated with reductions in survival (adjusted hazard ratio [aHR], 2.13; 95% CI, 1.97-2.30; P <.001), whereas palliative care initiated 31 to 365 days following cancer diagnosis was associated with survival improvements (aHR, 0.47; 95% CI, 0.45-0.49; P <.001). No difference in survival was observed when palliative care was received >365 days following diagnosis (aHR, 1.00; 95% CI, 0.94-1.07: P =.91).

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Compared with not receiving palliative care, patients who did receive palliative care had a reduced risk for death in an acute care environment (adjusted odds ratio, 0.57; 95% CI, 0.52-0.64; P <.001). Palliative care was also associated with an overall reduction in the risk for mortality (aHR, 1.19; 95% CI, 1.15-1.23; P <.001).

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Study limitations included its retrospective nature, the analysis of only patients who received care in the VA healthcare system, and the large percentage of men (98%).

Based on their findings, the researchers wrote “that palliative care should be considered a complementary approach to disease-modifying therapy in patients with advanced lung cancer.”


Sullivan DR, Chan B, Lapidus JA, et al. Association of early palliative care use with survival and place of death among patients with advanced lung cancer receiving care in the Veterans Health Administration [published online September 19, 2019]. JAMA Oncol. doi:10.1001/jamaoncol.2019.3105