Video Visits Equivalent to In-Person Visits for Early Palliative Care of Patients With Advanced Cancer
Key findings
- REACH PC, a randomized, multisite trial, compared the effectiveness of telehealth and in-person visits for delivering early palliative care services to patients with advanced non–small cell lung cancer
- 1,250 patients were enrolled, making REACH-PC the largest known prospective trial to directly compare video vs. in-person visits for providing outpatient palliative care
- At week 24, patients in the two groups reported equivalent quality of life and did not differ in their satisfaction with care, anxiety/depression symptoms, coping strategies, or perceptions of the primary goal of treatment and curability of their cancer
- The proportion of palliative care visits with a caregiver present was higher in the in-person group, while caregiver-reported quality of life and all other outcomes were similar in the two treatment groups
- This study adds critical evidence to support ongoing access to palliative care and telehealth services, especially for vulnerable populations with serious illness
Palliative care should be integrated into oncology care as soon as advanced cancer is diagnosed, national guidelines recommend. Unfortunately, most patients and their families don't have early consultations with palliative care specialists because of barriers such as transportation time and costs, impairing physical symptoms, and clinician staffing shortages.
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Jennifer Temel, MD, and Joseph A. Greer, PhD, co-directors of the Cancer Outcomes Research & Education Program at Mass General Cancer Center, and Vicki Jackson, MD, chief of the Division of Palliative Care & Geriatric Medicine at Massachusetts General Hospital, along with colleagues at 21 other cancer centers addressed this care gap in the REACH PC trial.
As they report in JAMA, video visits were equivalent to in-person visits for improving quality of life (QOL) in outpatients with advanced lung cancer.
Flexibility in Scheduling Was Permitted
Between June 14, 2018, and May 4, 2023, REACH PC enrolled 1,250 patients who had been diagnosed with advanced non–small cell lung cancer within the past 12 weeks, were not being treated with curative intent, and had an Eastern Cooperative Oncology Group Performance Status Scale score of 0 to 3.
Participants were scheduled to meet with a palliative care physician or advanced practice provider at least every 4 weeks for 48 weeks. They were randomly assigned 1:1 to either in-person visits or one initial in-person visit followed by video visits. If necessary, clinicians could schedule participants in either study group to have a telephone, video, or in-person visit. Patients in the video visit group who lacked necessary technology received a cellular-enabled tablet computer.
Video and In-Person Visits Were Similar on Multiple Outcomes
The primary outcome was patient QOL as measured with the Functional Assessment of Cancer Therapy–Lung (FACT-L) at week 24. At that point, 620 participants were still alive and had complete data. Of all 2,306 encounters within the video visit group by week 24, 69% occurred over video, 21% were in person per protocol, and 10% were in person at the clinician's or patient's request. Within the in-person group, 6% of 2,038 encounters occurred via video during the COVID-19 pandemic.
The adjusted mean FACT-L score was 99.7 in the video visit group and 97.7 in the in-person group (P=0.04 for equivalence). The mean improvement in FACT-L score from baseline to week 24 was 8.4 and 6.9 points, respectively. Thus, both groups exceeded the clinically meaningful change of 6 points.
The study groups did not differ in scores on any other self-report instrument completed:
- Satisfaction and Care Delivery Questionnaire
- Hospital Anxiety and Depression Scale
- Patient Health Questionnaire–9, which assesses depressive symptoms
- Brief Coping Orientation to Problems Experienced Inventory
- Prognosis and Treatment Perceptions Questionnaire
No Difference Between Groups in Caregiver Outcomes
Enrolled patients had the option to identify a caregiver to complete the same self-report surveys, except the FACT-L was replaced with the CareGiver Oncology Quality of Life questionnaire. 548 caregivers were enrolled, usually a spouse or partner.
By week 24, the rate of caregiver participation in visits was lower in the video visit group than in the in-person visit group (37% vs. 50%; P<0.001). Nonetheless, the video visit group and the in-person visit group did not differ significantly in scores on any of the caregiver self-report measures.
Video Visits Offer Greater Autonomy
Many patients with advanced cancer require transportation assistance to attend in-person visits, which may explain why caregiver participation was greater in that group. Video visits may allow patients and caregivers greater flexibility to decide whether to jointly participate in visits, reducing the time and travel burden on caregivers.
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