Boston, MA—A long-awaited cost analysis of a randomized trial comparing early palliative care with standard care in patients with metastatic non–small-cell lung cancer (NSCLC) did not produce results that reached statistical significance, but the findings were positive, the researchers said, given that early palliative care has been shown to improve survival and other outcomes.
“Early palliative care has been shown to improve quality of life, mood, and end-of-life care in patients with metastatic NSCLC,” said Joseph A. Greer, PhD, a clinical psychologist at Massachusetts General Hospital, Boston, who presented the study at the 2014 Palliative Care in Oncology Symposium.
“The marginally significant findings show that early palliative care was associated with a lower average total cost per day of $117 compared with standard care,” said Dr Greer. “In the final month of life, costs were greater for hospice care, but less for chemotherapy in the early palliative care group compared with standard care.”
According to an estimate from a 2011 study, the average cumulative total healthcare cost for metastatic lung cancer is $125,849 (Vera-Llonch M, et al. BMC Health Serv Res. 2011; 11:305). Palliative care may be one method of reducing these healthcare costs. Inpatient palliative care consultations have been associated with significant savings for hospital costs (May P, et al. J Palliat Med. 2014;17:1054-1063), yet little is known about the impact of outpatient early palliative care on the overall costs of care.
Clinical Outcomes
A landmark randomized controlled trial conducted at Massachusetts General Hospital demonstrated that early palliative care improved survival, quality of life, and depression in patients with metastatic NSCLC (Temel JS, et al. N Engl J Med. 2010;363:733-742). The study randomized 151 patients with newly diagnosed metastatic NSCLC to receive either standard cancer care alone or early palliative care integrated with standard care.
Patients in the palliative care arm met with palliative care clinicians monthly, whereas patients in the standard oncology arm met with palliative care clinicians only when the patient or family requested it. Although fewer patients in the early palliative care group than in the standard care group received aggressive end-of-life care (33% vs 54%, respectively; P = .05), the median survival was longer among patients receiving early palliative care (11.6 vs 8.9 months, respectively; P = .02).
A New Cost Analysis
At the meeting, Dr Greer presented the results of a new, secondary analysis of the original study, which calculated the cost of care throughout the original study and at the end of life in terms of hospitalizations and emergency department visits, outpatient clinic visits, chemotherapy administration, and hospice services.
Although many of the costs showed a trend toward a cost-savings for the palliative care arm, the results did not reach statistical significance (Table 1 and Table 2).
“Although this secondary analysis lacked statistical power, the delivery of early palliative care for patients with metastatic NSCLC does not appear to increase health care expenses over the course of disease or at the end of life.”
Dr Greer said that future studies of early palliative care models need to include sufficiently powered cost analyses that assess relevant inpatient, outpatient, and homecare services.
Eduardo Bruera, MD, Professor and Chair, Department of Palliative Care and Rehabilitation Medicine, M.D. Anderson Cancer Center, Houston, discussed the study at the symposium. Dr Bruera said that the research was important, because it showed that the costs of early palliative care were not higher than standard care, but that the expenses had a different distribution.