Palliative care for cancer patients is found to be as effective given virtually as in person

CHICAGO — Comfort can be delivered to patients with advanced cancer virtually just as well as in person, according to a new study presented on Sunday at the American Society of Clinical Oncology annual meeting in Chicago.

That’s welcome news to palliative care experts who have, in many cases, preferred the convenience and efficacy of telehealth sessions for both themselves and their patients since the Covid-19 pandemic forced virtual visits.

“I can sit in my office or at home and do patient after patient. It doesn’t increase the number of healthcare professionals doing palliative care, but it does increase the efficiency,” said Thomas Smith, a medical oncologist and palliative care specialist at Johns Hopkins Sidney Kimmel Comprehensive Cancer Center who did not work on the study. “These are very timely studies. I’m glad we have them. There simply aren’t enough palliative care professionals to provide the care that’s needed.”

Most patients with an advanced cancer diagnosis do not receive palliative care, which is sometimes conflated with hospice or end of life care. Palliative care clinicians provide support to patients and their families, trying to help ease their journey through any serious illness like cancer at any point. That could be helping patients to manage pain or anxiety, to understand their disease better, or even discuss existential questions.

“This is focused on quality of life,” said Joseph Greer, a psychologist at Mass General Hospital Cancer Center and the lead author on the study. “Symptom management, emotional and functional wellbeing and spiritual wellbeing.”

It may not be treating the patient’s cancer directly, but comfort is nothing to wave your hand at, Greer said. He and his colleague, MGH Cancer Center oncologist Jennifer Temel, showed over a decade ago that when physicians integrated palliative care early, patients actually lived longer compared to patients who didn’t receive early palliative care.

“The people who got palliative care and symptom management lived 2.7 months longer. That’s been seen in several other trials,” Smith said. In other studies, Smith said, palliative care has been shown to increase the survival of patients by around 10% after a year or two. “Most oncologists would kill for a drug that would give them that improvement in survival.”

Moving palliative care sessions to telehealth might enable more patients to get such care — assuming there was no great loss from not being in person. To test that, Greer and Temel started this study seven years ago and recruited 1,250 patients with advanced lung cancer. Half of them were randomly assigned to receive palliative care virtually, while the other half were asked to trek into the cancer center for monthly visits.

At the end of the study, there was no statistically significant difference between the groups in terms of their depression and anxiety symptoms, use of coping skills, or their understanding of their treatments and cancer prognosis. Some of the patients also invited their caregivers to participate in the study, Greer said, and caregivers in both groups also reported similar outcomes in terms of satisfaction with the program and emotional symptoms.

These results should provide a rationale for continuing or even expanding telehealth palliative care programs, especially when considering more intangible benefits of virtual visits, said Elizabeth Loggers, an oncologist and palliative care specialist at the Fred Hutchinson Cancer Center.

“When palliative care is delivered via telehealth, there are a number of advantages. They can be at home, in their pajamas, and their caregivers or anyone else across the country can sit in on that appointment to act as support,” she said. “It also allows them to participate at times when they feel their worst. The difficulties of in person is, when you feel your worst, you’re least likely to drive to the center to be seen.”

Virtual visits may also increase the efficiency of the healthcare system, Loggers added, since physicians may not have to wait for patients to get into an exam room, check in, or simply be late to their appointment. These advantages may simply help a greater proportion of patients get palliative care, when so few currently have access, Loggers said.

Palliative care experts are also looking at other ways to help more patients get seen. In another abstract presented at ASCO in Chicago and published in JAMA by MGH’s Temel, she showed the frequency of palliative care visits could be stepped down for patients with fewer physical or emotional symptoms — also without any loss in palliative care efficacy.

Hopefully, she said, these studies will help more centers find ways to bring palliative care to more of their patients. “The means or strategies we have for providing palliative care are widened,” she said. “We know it’s the best way to take care of patients, and we want to make sure more patients are accessing this essential service.”