Telehealth Palliative Care Comparable to In-Person Visits

Opting for palliative care via telehealth may be more convenient and just as effective as in-person care.

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Among patients with advanced non-small cell lung cancer (NSCLC), early palliative care delivered virtually has been shown to be as effective as in-person care. These findings, researchers told CURE®, may reduce the burden placed on patients during their cancer journey.

“People can access the really holistic type of care that they need in coping with a serious illness like advanced lung cancer using telehealth, using video visits, and they can receive high-quality care in that way, and that the type of care they receive over that modality is just as effective in improving their quality of life as it would be if they were seeing the clinician in person,” said Joseph Greer, a clinical psychologist and co-director of the Cancer Outcomes Research and Education Program at Massachusetts General Hospital.

“And, for a population where they may be living far from clinic, or maybe they're struggling with side effects, or even just, frankly, don't want to deal with all the like burdens of travel on the cost of that, this is a real benefit for reducing that burden,” Greer said in an interview.

LEARN MORE: How Patients With Cancer Can Prepare for Virtual Care Visits

Greer and his co-director of the Cancer Outcomes Research and Education Program, Dr. Jennifer Temel, are the lead authors of a study published in JAMA and the findings of which were presented earlier this year in a plenary session at the American Society of Clinical Oncology annual meeting.

The REACH-PC study enrolled 1,250 patients within 12 weeks of receiving a diagnosis of advanced NSCLC as well as 548 caregivers and assigned them two groups to either meet with a trained palliative care clinician every four weeks either through a telehealth video visit or in person, with members of the video group having an initial in-person visit.

After 24 weeks, the participants had a mean of 4.7 video visits and 4.9 in-person visits, with researchers reporting that quality-of-life scores were equivalent between the two groups. On the Functional Assessment of Cancer Therapy-Lung Questionnaire, which measures patient-reported quality of life on a scale of 0 to 136, the mean scores were 99.7 and 97.7 in the telehealth and in-person groups, respectively, according to the study findings published in JAMA.

Likewise, researchers reported similar outcomes between the two groups regarding caregiver quality of life, patient coping, patient and caregiver satisfaction with care, mood symptoms and prognostic perceptions.

“We know that when patients are cared for by both an oncology team and a palliative care team, they feel better and they have higher quality care and outcomes,” said Temel in an interview. “So that is not in question. The challenge that we have is that there are not enough palliative care clinicians to see all patients with advanced cancer, and the settings where most people in the U.S. receive health care don't have palliative care clinicians. We just don't have enough of them.

“And so, one of our primary goals or impetus of doing this study was to sort of see if telehealth was an effective modality for delivering palliative care. And then in future work, we'll see, does that increase the scalability or reach of palliative care to be able to deliver it with video visits?”

Of note, fewer caregivers participated in telehealth palliative care compared to in-person care — 36.6% versus 49.7%, respectively.

While researchers hypothesized that more family or friends would join in on virtual visits, the results prompted an “a-ha” moment, as Temel explained, “Most people with lung cancer are 65 or older and they're sick, which means they actually need someone to drive them to the clinic for in-person visits, and that's probably why there were more caregivers present in person.”

Palliative care may address some problems regarding access to care — nearly half (45.7%) of patients in this sample reported having to travel at least an hour to the cancer clinic — but there are also issues regarding telehealth. For example, patients in the study’s video group without the necessary technology for a video chat had to receive a cellular-enabled tablet computer in order to participate in the study.

The study in question was conducted from 2018 to 2023. The digital divide, Greer said, continues to lessen over time, with many patients able to access telehealth services via a smartphone.

“However, there's still a divide,” he said. “There are people who do not have the resources to have that type of technology and the infrastructure around access to wi-fi and zones where you can really be able to use technology effectively. … There are some rural regions where it's really hard to have reliable internet, and so that also is an issue that we have to think about.

“And then, I would say the other considerations are for people who have maybe visual or hearing impairments or other types of sensory disabilities, the technology can be tricky, and it's not always an optimal method for a conversation with a clinician. And so, while there are many strengths to having video visits, particularly giving an opportunity for the clinician to see the patient in their home environment and have them be more comfortable and outside the sort of standard office setting, that's really great, for those people who do need extra support because of various disabilities that can be trickier. So, there are definitely issues there.”

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