Patient-Reported Outcomes Of Early Integration Palliative Care In Quality Of Life And Symptom Burden In Advanced Lung Cancer - A Randomized Study

Early palliative care (EPC) integration in advanced lung cancer (LC) care is difficult to execute in a resource-limited setting. We aimed to implement and study the impact of EPC in patient-reported (PtR) quality of life (QoL) and symptom burden (SB) during the course of the disease. This was a prospective unicentric study of consecutive unresectable stage III/IV LC patients, randomized to EPC integrated in standard oncologic care or standard oncologic care alone (SOC). From October 2019-April 2020, QoL and SB were assessed every 3 weeks(w) using EORTC QLQ-C30 questionnaire version 3 (5 functional [physical, role, emotional, cognitive and social], 1 global health status (GHS)/QoL, 9 symptom subscales) and Functional Assessment of Cancer Therapy–Lung (FACT-L) scale version 4 (physical (PWB), social (SWB), emotional, functional (FWB) well-being, lung cancer (LCS) subscales). Trial Outcome Index (TOI) represents PWB, FWB and LCS. Higher scores indicate better QoL. We included 34 patients (16 EPC, 18 SOC) with a median age of 66 years [48-81], 74% male, 97% ECOG PS 0-1. Histology was 88% non-small and 12% small cell LC; 44% had stage III and 56% IV. There were no differences between groups, including treatments. Median follow-up was 22w. Table represents score variations from baseline up to 15w (QoL, FACT-L and TOI). At baseline, subscales were similar between groups, except for higher scores in physical functioning for EPC. At 15w, higher scores were reported in EPC cohort for QoL, TOI, FACT-L and all functioning subscales except for cognitive. The SOC group experienced more fatigue, pain, insomnia and appetite loss.Table 1514PPtR outcomes (median, [interval])Baseline15wDifferencepGHS/QoL (score range (sr) 0-100) SOC50 [8.3-100]50 [16.7-100]0 [-33-42]0.001EPC50 [0-100]92 [33-100]33 [-17-75]FACT-L (sr 0-136) SOC78 [41-102]74 [55-101]0 [-37-60]0.014EPC96 [51-117]112 [60-127]14 [-30-58]TOI (sr 0-84) SOC52 [12-71]52 [26-62]0 [-23-45]0.001EPC55 [32-68]67 [36-77]12 [-13-33] Open table in a new tab EPC led to a significant benefit in PtR QoL and SB compared to SOC. Our data encourages the implementation of EPC as standard in advanced LC, as differences were observed even within a small cohort of patients. Ongoing follow-up will demonstrate its impact on survival.