title: Effects of Early Integrated Palliative Care in Patients With Lung and GI Cancer: A Randomized Clinical Trial.
abstract: Purpose We evaluated the impact of early integrated palliative care (PC) in patients with newly diagnosed lung and GI cancer. Patients and Methods We randomly assigned patients with newly diagnosed incurable lung or noncolorectal GI cancer to receive either early integrated PC and oncology care (n = 175) or usual care (n = 175) between May 2011 and July 2015. Patients who were assigned to the intervention met with a PC clinician at least once per month until death, whereas those who received usual care consulted a PC clinician upon request. The primary end point was change in quality of life (QOL) from baseline to week 12, per scoring by the Functional Assessment of Cancer Therapy-General scale. Secondary end points included change in QOL from baseline to week 24, change in depression per the Patient Health Questionnaire-9, and differences in end-of-life communication. Results Intervention patients ( v usual care) reported greater improvement in QOL from baseline to week 24 (1.59 v -3.40; P = .010) but not week 12 (0.39 v -1.13; P = .339). Intervention patients also reported lower depression at week 24, controlling for baseline scores (adjusted mean difference, -1.17; 95% CI, -2.33 to -0.01; P = .048). Intervention effects varied by cancer type, such that intervention patients with lung cancer reported improvements in QOL and depression at 12 and 24 weeks, whereas usual care patients with lung cancer reported deterioration. Patients with GI cancers in both study groups reported improvements in QOL and mood by week 12. Intervention patients versus usual care patients were more likely to discuss their wishes with their oncologist if they were dying (30.2% v 14.5%; P = .004). Conclusion For patients with newly diagnosed incurable cancers, early integrated PC improved QOL and other salient outcomes, with differential effects by cancer type. Early integrated PC may be most effective if targeted to the specific needs of each patient population.
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Greer
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Areej
authors.initials: A
authors.lastname: El-Jawahri
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: William F
authors.initials: WF
authors.lastname: Pirl
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Elyse R
authors.initials: ER
authors.lastname: Park
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Jackson
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Back
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Mihir
authors.initials: M
authors.lastname: Kamdar
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Juliet
authors.initials: J
authors.lastname: Jacobsen
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Eva H
authors.initials: EH
authors.lastname: Chittenden
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Simone P
authors.initials: SP
authors.lastname: Rinaldi
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Gallagher
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Justin R
authors.initials: JR
authors.lastname: Eusebio
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Zhigang
authors.initials: Z
authors.lastname: Li
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: Alona
authors.initials: A
authors.lastname: Muzikansky
authors.affiliation: Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Simone P. Rinaldi, Emily R. Gallagher, Justin R. Eusebio, Alona Muzikansky, and David P. Ryan, Massachusetts General Hospital; Jennifer S. Temel, Joseph A. Greer, Areej El-Jawahri, William F. Pirl, Elyse R. Park, Vicki A. Jackson, Mihir Kamdar, Juliet Jacobsen, Eva H. Chittenden, Alona Muzikansky, and David P. Ryan, Harvard Medical School, Boston, MA; Anthony L. Back, University of Washington, Seattle, WA; and Zhigang Li, Geisel School of Medicine at Dartmouth, Lebanon, NH.
authors.forename: David P
authors.initials: DP
authors.lastname: Ryan
mesh_terms: D000368:Aged; D003131:Combined Modality Therapy; D003863:Depression / Q000209:etiology / Q000523:psychology / Q000628:therapy; D005260:Female; D005770:Gastrointestinal Neoplasms / Q000523:psychology / Q000628:therapy*; D006801:Humans; D008175:Lung Neoplasms / Q000523:psychology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life