Lung cancer is the second most common cancer treated within VA and is the leading cause of cancer related death among Veterans. Lung cancer is of particular interest within VA because of the high prevalence of current and past tobacco consumption. The care of patients with lung cancer has been demonstrated to be heterogeneous. A recent VA Cancer Quality study assessed the quality of cancer care for patients diagnosed with stage IV colorectal, pancreatic or lung cancer. Palliative care measures, e.g. outpatient pain and dyspnea assessment, indicate the national rate for initial pain screening is 58% and only 15.8% for dyspnea. Goals of care were addressed in only 17.7% of patients in the month after a diagnosis of advanced cancer. These measures demonstrate variation in symptom assessment and delivery of outpatient palliative care in the treatment of lung cancer, which likely results in unnecessary symptom burden and poorer quality of life. Palliative care improves the quality of life of patients for problems associated with life-limiting illness through the prevention and relief of suffering by early identification, assessment, and treatment of pain and other physical symptoms including psychological and spiritual needs. Palliative care is supportive care integrated into curative care independent of stage of illness. The conceptual tenets of palliative care services are concordant with being Veteran-centric and align with VA Blueprint and the Office of Nursing Service Strategic Plan to provide Veterans personalized, proactive, patient-driven health care and achieve measureable improvements in health outcomes. This proposal also aligns with the VA's Comprehensive End of Life Care initiative to reduce variations and increase access to quality palliative care across the system, especially in the outpatient arena. Despite guideline recommendations to integrate palliative care into curative care, the majority of patients do not receive palliative care services until all curative options are exhausted. Initiating early palliatve care shortly after lung cancer diagnosis may provide an opportunity to improve this aspect of care. The purpose of this study is to test the efficacy of delivering a nurse -led telephone-based intervention that includes the early provision of palliative care to improve patient-centered outcomes for Veterans with newly diagnosed lung cancer. This nurse-led intervention will focus on patients across the spectrum of stages of disease and is designed to determine the effect of the intervention on patient quality of life, symptom burden and satisfaction of care. We will also determine the effect of the intervention on patient activation to discuss treatment preferences with their clinician and on clinician knowledge of patients' goals of care. Patients meeting entry criteria will be randomized to the intervention arm, palliative care plus usual care or the usual care arm. Patients randomized to the intervention arm will receive usual oncologic care and phone calls from a nurse. Outcomes measures will be collected at baseline, and at the end of the patients' primary cancer treatment. The study will be performed at the Puget Sound Health Care System and Birmingham VA Health Care System. We will recruit individuals (n=128) with lung cancer over 2.5 years. The results of this study will inform a future effectiveness/implementation study.
The focus of the study is to test a nurse-led telephone-based palliative care intervention on improving the delivery of care for patients with newly diagnosed lung cancer. The results of several VA funded pilot studies serve as the key motivator for this proposal, as this work identified several unmet physical and psychosocial needs of Veterans newly diagnosed with lung cancer. Our pilot data demonstrates the intervention is feasible to conduct and is acceptable to patients. The proposed study is a two-site randomized control trial aimed to determine the efficacy of the intervention on improving patients' quality of life, symptom burden and satisfaction of care. Additionally, the study will test an innovative care delivery model to improve patients' access to palliative care.
