Background: Research has established the role of early specialist palliative care (SPC) referral in patients diagnosed with advanced non-small cell lung cancer (NSCLC). Ground-breaking treatments including immunotherapy hold therapeutic optimism and potentially uncertainty as to the optimal timing of SPC referral.
Aims: This study explored the current practice for timing of SPC referral for patients receiving immunotherapy for metastatic NSCLC at a regional cancer centre in Geelong, Australia.
Methods: This was a retrospective cohort study of consecutive patients with metastatic NSCLC receiving first-line immunotherapy between January 2019 and June 2020. Descriptive statistics were used to summarise data. Fisher’s exact test was the test for association between variables, with a p-value <0.05 considered statistically significant.
Results: Forty-five patients met the study criteria, 51% were female, with mean age 66 years. SPC referral occurred for 31 patients (68.9%). Problems evident at the first SPC assessment included mild-moderate non-pain symptoms (83.9%), mild-moderate psychosocial/spiritual concerns (87%) and mild-moderate family/carer problems (94%). Median time to SPC referral was 21 days after first immunotherapy treatment (range 414 days before treatment, to 267 days after). Of referred patients, 12 who were alive at the close of data collection had a median time since referral of 331 days (range 42-1077 days); 19 decedents had a median duration of SPC involvement of 70 days (range 12-245 days).
Conclusions: There was a breadth of timings for SPC referral, with biopsychosocial problems frequently encountered at first SPC assessment. It seems likely that continuing advances in cancer management will be accompanied by changes in metastatic disease and adverse effects profiles, and with this the requirement for SPC services to be adaptive in their approach to care provision moving forward. This study highlights the importance of continuing to establish evidence-based SPC delivery models to benefit patients and carers into the future.