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Advancements in telehealth have revolutionized how healthcare is delivered, especially for patients with advanced stage lung cancer. The REACH-PC trial, presented at the American Society of Clinical Oncology (ASCO) annual meeting, demonstrates that early palliative care delivered via video can be as effective as in-person visits. This finding has significant implications for enhancing patient access to quality care and improving overall well-being. Let's explore the benefits of virtual care for advanced stage lung cancer patients.
The REACH-PC trial revealed that palliative care delivered through video visits achieved equivalent quality-of-life (QoL) outcomes compared to traditional in-person visits. This conclusion was drawn using the Adjusted Mean Functional Assessment of Cancer Therapy-Lung (FACT-L) scores, where higher scores indicate better QoL. At 24 weeks, the adjusted FACT-L scores were nearly identical between the two groups, proving that virtual care can maintain the same high standards of patient care as face-to-face interactions.
Both patients and caregivers reported high levels of satisfaction with virtual palliative care. Approximately 41% of patients and 37% of caregivers expressed satisfaction with the care received, showing no significant difference between video and in-person visits. This suggests that virtual care can effectively meet the emotional and psychological needs of patients and their families.
The trial also found no significant differences in patient-reported anxiety and depression symptoms between the video-visit and in-person groups. This is particularly important for lung cancer patients, who often experience significant psychological distress. Virtual care provides a reliable means to address these issues without compromising on the quality of support.
One of the major barriers to palliative care for advanced stage lung cancer patients is the limited availability of specialized clinicians and the logistical challenges of accessing care. Virtual care effectively removes these obstacles, making it easier for patients to receive timely and consistent support. As noted by Charu Agarwal, MD, MPH, from the University of Pennsylvania, telehealth technology can significantly reduce the burden on patients and expand the reach of palliative care services.
Telehealth has the added advantage of reducing healthcare-related costs and travel time for patients. This is particularly beneficial for those who are immunocompromised or frail, as it minimizes the risk of infection and the physical strain of travel. Furthermore, virtual visits can help manage symptoms such as fatigue, pain, and dyspnea more conveniently, as care can be provided from the comfort of the patient's home.
The findings from the REACH-PC trial are expected to inform future healthcare policy, particularly regarding the coverage of virtual care visits. Embracing telehealth could lead to more inclusive and accessible palliative care options, ensuring that even those in remote or underserved areas can receive high-quality support. However, further research is needed to enhance the representation of diverse patient backgrounds and to explore how intervention effects may vary across different subgroups.
Virtual care offers a promising solution for delivering early palliative care to advanced stage lung cancer patients. The REACH-PC trial confirms that video visits can achieve the same quality of life improvements as in-person visits, while also offering numerous additional benefits, including enhanced access to care, high satisfaction rates, effective management of psychological symptoms, and reduced costs. As telehealth continues to evolve, it holds the potential to transform the landscape of palliative care, making it more accessible and effective for all patients.
Lung cancer is the second most common cancer in the United States, just behind prostate cancer in men and breast cancer in women. Lung cancer also happens to be the most lethal cancer, accounting for approximately 25% of all cancer deaths. Each year, more men die of lung cancer than from colorectal, prostate, and pancreatic cancers combined, and more women die annually of lung cancer than from breast, cervical, and uterine cancers combined.
The main risk factor for lung cancer is cigarette smoking, associated with 85% of cases. Among smokers, the risk of lung cancer increases with number of cigarettes smoked and duration of smoking history. There is good news though: the risk of lung cancer will decrease with smoking cessation and may even approach that of the nonsmoking population after 10 to 15 years of tobacco abstinence. Meanwhile, associated risks of developing lung cancer from e-cigarettes are currently under investigation.
Each year in the U.S., up to 26,0000 lung cancer deaths occur in never smokers, with an even higher proportion in some geographic areas. This brings us to environmental risk factors of lung cancer, such as exposure to radon, a chemically inert gas from uranium decay, encountered by underground miners and less commonly, residentially, through indoor exposure in the home basement. Asbestos exposure can lead to a type of lung cancer called mesothelioma and can cause other types of lung cancer when combined with smoking.
Arsenic, chromium, nickel, air pollution, and second-hand smoke represent other occupational or environmental exposures associated with lung cancer risk. Patients with treated for breast cancer, Hodgkin and non-Hodgkin lymphomas with high doses of radiation to the chest have increased risk of lung cancer, especially if they smoke cigarettes. Family history is another predictor of increased risk. Other diseases associated with increased lung cancer risk include chronic obstructive pulmonary disease and restrictive lung diseases, including fibrotic disorders like pneumoconiosis.
Finally, there have been dietary associations with lung cancer. An increased risk has been found with diets deficient in vitamins A and C, but supplementation with beta-carotene has been associated with an increased risk (in heavy smokers, the highest-risk populations, in 2 of 3 clinical trials).
On the basis of findings from the NLST trial, screening for lung cancer with low-dose computed tomography (LDCT) scan is recommended for certain patients by the U.S. Preventive Services Task Force (USPSTF). See Table 1.
Table 1. USPSTF Recommendation Summary for Lung Cancer Screening
| Population | Recommendation |
| Adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years | The USPSTF recommends annual screening for lung cancer with low-dose computed tomography (LDCT) in adults aged 50 to 80 years who have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years. Screening should be discontinued once a person has not smoked for 15 years or develops a health problem that substantially limits life expectancy or the ability or willingness to have curative lung surgery. |
Adults aged 50 to 80 years have a 20 pack-year smoking history and currently smoke or have quit within the past 15 years should screen for lung cancer with LDCT every year. A pack-year is a way of calculating how much a person has smoked in their lifetime. One pack-year is the equivalent of smoking an average of 20 cigarettes (1 pack) per day for a year. These recommendations are available at www.uspreventiveservicestaskforce.org.
If you would like to learn more and connect with a board-certified physician, click to book now on My Virtual Physician. My Virtual Physician offers comprehensive medical services where you can discuss the best screening plan for you with a virtual doctor.
References
https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
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