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ASCO 2024: Lung Cancer

CME

Conference to Clinic: Expert Analysis of the Top Abstracts in Lung Cancer From the 2024 Oncology Meeting in Chicago

Physicians: Maximum of 1.00 AMA PRA Category 1 Credit™

Released: August 23, 2024

Expiration: February 22, 2025

Natasha Leighl
Natasha Leighl, MD, MMSc, FRCPC, FASCO
Zofia Piotrowska
Zofia Piotrowska, MD
CME/CE Information

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REACH-PC: Background

Zofia Piotrowska, MD:
The final abstract we discuss is the REACH-PC trial, presented at ASCO 2024’s plenary session by Dr Joseph Greer and colleagues from Massachusetts General. This study examined the role of palliative care for patients with advanced NSCLC.41 Although it was presented in the lung cancer session, its implications can be applied more broadly to all patients with cancer. I think all patients with cancer may benefit from the approaches being evaluated in this study.

The REACH-PC study compared telehealth vs in-person visits for delivering early palliative care to patients with advanced NSCLC. This study was designed based on prior data by Temel and colleagues,42 which showed that early introduction of palliative care improves quality of life and may even improve survival for patients with advanced NSCLC, as demonstrated in a landmark study published more than a decade ago.

Early palliative care has long been known to enhance the quality of life for patients. However, access to palliative care is often limited and variable, making referrals challenging. REACH-PC, conceived long before the COVID-19 pandemic, had the foresight to explore whether telehealth or video visits could improve access to palliative care and whether early palliative care delivered via telehealth would be equivalent to in-person care.41

REACH PC: Telehealth vs In-Person Visits for Delivery of Early Palliative Care for Patients With Advanced NSCLC

Zofia Piotrowska, MD:
The REACH-PC trial was a multicenter, randomized study conducted across 22 sites in the United States that enrolled patients (N = 1250) from 2018 to 2023.41 Enrolled patients were adults diagnosed with advanced NSCLC who were receiving cancer treatment and able to participate in the study and complete questionnaires. Cancer treatments were not given with curative intent.

Patients were randomized into 2 groups: video visit arm, which included monthly video visits following an initial in-person encounter to establish rapport, and the in-person visit arm, which involved monthly in-person visits.

The primary endpoint of the study was patient quality of life, assessed using the FACT-L measurement. Key secondary endpoints included patient and caregiver satisfaction with care, as well as caregiver attendance at study visits.

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REACH PC: Delivery of Intervention

Zofia Piotrowska, MD:
The outcomes of the REACH-PC trial showed that the number of visits patients received was equivalent in both arms.41 Remarkably, despite much of the study occurring during the COVID-19 pandemic, when many medical consultations transitioned to video visits, the initial assigned treatment arms for patients were maintained with high fidelity. Almost all visits for patients in the video visit arm were conducted via video (87%), and almost all those assigned to in-person visits primarily had in-person consultations (94%).

Healthcare professionals documented the topics discussed during these visits, revealing that the types of conversations were quite similar across both formats. This suggests that the mode of delivery did not significantly alter the nature of the palliative care provided.

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REACH PC: Key Patient Outcomes

Zofia Piotrowska, MD:

In the REACH-PC trial, there was no difference in patient quality of life, assessed by the FACT-L, between the video and in-person delivery of care, indicating both formats were equally effective.41 Patient satisfaction with care was also equivalent, with patients receiving video visits being as satisfied as those receiving in-person care.

 

Of interest, caregiver attendance at visits was higher in the in-person visit arm of the study. Greer and colleagues discussed that they had anticipated equivalent or even higher attendance in video visits, assuming caregivers could be at home with the patient. The presence of caregivers at in-person visits was likely because of transportation constraints; patients often needed someone with them for in-person visits, whereas video visits could be conducted alone. This suggests that some patients might prefer to have certain conversations privately, without a caregiver present. This unexpected result will likely be evaluated further in future studies.

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REACH-PC: Clinical Implications

Zofia Piotrowska, MD:
The REACH-PC study reminds us of the importance of early palliative care for patients with advanced NSCLC. Early involvement in palliative care can improve patient outcomes in terms of both quality of life and possibly survival. The study also validates video visits as an appropriate method for delivering palliative care.

I hope that in the future, there will be increased access to palliative care nationwide, especially in communities where such services are limited. Telehealth may broaden the availability of early palliative care.

REACH-PC is an important reminder that we need to consider and discuss palliative care involvement with patients from the time of initial diagnosis.

Final Conclusions

ASCO 2024 showcased a number of exciting abstracts. Highlights included an unprecedented study showing the benefit of immunotherapy for LS- SCLC and significant progress in biomarker-driven treatments for unresectable, stage III NSCLC as well as advanced NSCLC. In addition, the conference emphasized the importance of patient-centered care, showcasing a study that explored the effectiveness of early palliative care. Many of the studies mentioned here will immediately change clinical practice whereas others are in the earlier stages of development, but the overall goal is to improve outcomes for patients with lung cancer worldwide.

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