Palliative Care Proves Beneficial for Veterans With Cancer

Donald Sullivan, MD, MA, MCR, and colleagues recently published a study in JAMA Oncology on the association between palliative care and survival rates, particularly among lung cancer patients in the veteran population. Veterans Health Today spoke with him about the results of their study. 

Please introduce yourself and explain a bit about your background.

My name is Donald Sullivan. I’m an associate professor of medicine at Oregon Health and Science University, the division of pulmonary and critical care medicine. I’m also a core investigator at the VA Portland Health Care System, in health services research and development.

In terms of my research, I’m a health services researcher with a focus on ways to improve outcomes and quality of care among patients with lung cancer and other patients with those serious illnesses.

What interesting data led you and your co- investigators to conduct your research?

I have a background in mental health with a master’s in psychology. I was actually looking at the prevalence and the impact of depression and depression symptoms on patients with lung cancer in the VA health care system. 

Just knowing how prevalent mental health problems are among veterans and the comorbidity of lung cancer, and learning from the literature how palliative care can have a positive influence on psychological symptoms of disease. I started looking at outcomes associated with palliative care among lung cancer patients.

Can you please describe your study and its results? (doi:10.1001jamaoncol.2019.3105)

It is an observational study of all advanced stage lung cancer patients in the national VA health care system over a 7-year period.

We examined both use and the outcomes associated with palliative care. The specific outcomes for this study were survival and place of death. Then in terms of what outcomes were particularly surprising, palliative care was associated with improved survival and was received 31 to 35 days of the diagnosis.

Although Jennifer Temel’s study—her landmark study in palliative care in advanced stage lung cancer patients (doi:10.1056/NEJMoa1000678)—showed that palliative care could lead to improved survival, that result had never really been seen before. Our results showed this kind of benefit in such a large population using observational designs, and those results were really surprising to us.

What are the possible real-world applications of these findings in clinical practice?

I think one of the main parts of the research is it helps dispel the myth among both clinicians and patients that palliative care is only for patients at the very end of life. I think a lot of times it gets conflated with hospice care, and they are very different, although they are related.

The other myth is that palliative care leads to shorter survival. I think my research unequivocally shows that this is not true.

One of the questions you asked about how this would impact things in clinical practice—I hope this leads to more palliative care use and earlier use, not at the very end of life, among patients with advanced lung cancer.

I really think these results translate well to all patients with advanced cancer, and even, hopefully, patients with other serious illness like heart failure or [Chronic obstructive pulmonary disease], other patients I see quite a bit. I think these results would relate well to them.

Do you intend to expand upon this research?

This manuscript in this study was actually one component of a career development award that was funding this. There are actually several other manuscripts and studies I am in the process of submitting and developing.

One we’re looking at is determining if palliative care is associated with health care use in this national population. We’re also looking at what the particular elements of palliative care are, such as pain control measures and things like that that might contribute to benefits in patients.

Finally, this part of the study was an observational part, but overall, the study was actually a mixed message study design where I’m also interviewing VA clinicians from around the country in order to examine their experiences and firsthand accounts of palliative care use among advanced stage lung cancer patients in the VA health care system overall.

Is there anything else pertaining to your research or the findings that you would like to add?

I think one of the big things is that there are significant disparities when you look at research funding. Despite its importance in comprehensive cancer care, palliative care research is severely underfunded in the United States and worldwide.

Secondly, even though lung cancer is the leading cause of cancer-related mortality in the United States, lung cancer is among the worst funded cancers in the United States.

As a result, these patients’ five year survival has really not changed much over the last decade compared to other cancers and the benefits that they’ve seen.

I think one of the last parts for me that I want to add is just to acknowledge the generosity of the National Cancer Institute of the NIH because this was a career development award—that’s how this research was funded—and also acknowledge the support institutionally from both Oregon Health and Science University and the Portland VA for their support for getting this research done and in me as an investigator.