Stepped Palliative Care for Patients With Advanced Lung Cancer Maintains QoL

Background: Early palliative care intervention has been shown to improve quality of life (QoL) and extend survival in patients with advanced lung cancer, but routine application has been hampered by shortages of palliative care specialists in many geographic areas. A stepped-care model for palliative services based on patient-reported QoL is a potential avenue for addressing this problem by minimizing clinician interaction with patients who do not require frequent visits. Objective: To evaluate a stepped-care model to deliver less resource-intensive and more patient-centered palliative care for patients with advanced cancer. Design: Prospective, randomized, nonblinded noninferiority trial. Participants: 507 patients from 3 U.S. medical centers who were within 12 weeks of diagnosis of advanced non–small-cell lung cancer (NSCLC), small-cell lung cancer, or mesothelioma and had Eastern Cooperative Oncology Group performance status of 0 to or 2. Methods: After an initial palliative more...