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AHRQ--Agency for Healthcare Research and Quality: Advancing Excellence in Health Care

Topic Suggestion Description

View Topic Suggestion Disposition (PDF) 129 kB

Date submitted: June 01, 2011

Briefly describe a specific question, or set of related questions, about a health care test or treatment that this program should consider.
For patients with advanced or metastatic solid tumors such as non-small cell lung cancer, what is the comparative effectiveness of usual care plus interdisciplinary palliative care versus usual care alone in improving net health outcomes?
Does your question include a comparison of different health care approaches? (If no, your topic will still be considered.)
If yes, explain the specific technologies, devices, drugs, or interventions you would like to see compared:
Palliative care (provided by a multidisciplinary team of health professionals) integrated with standard oncologic care, as compared with standard oncologic care alone.
What patients or group(s) of patients does your question apply to? (Please include specific details such as age range, gender, coexisting diagnoses, and indications for therapy.)
Adults with advanced or metastatic cancer (both hospice and non-hospice care)
Are there subgroups of patients that your question might apply to? (For example, an ethnic group, stage or severity of a disease.)
Advanced (Stage III) or metastatic disease
Describe the health-related benefits you are interested in. (For example, improvements in patient symptoms or problems from treatment or diagnosis.)
Improvements in survival duration, quality of life, mood (e.g., anxiety, depression), and symptom severity over time (e.g., pain); as well as less use of aggressive care near the end-of-life (e.g., chemotherapy within 14 days before death, lack of hospice care, or hospice admission shortly before death).

Improvements in intermediate outcomes, such as patient and family satisfaction and use of health care services as a result of less use of aggressive care.
Describe any health-related risks, side effects, or harms that you are concerned about.
Impact on survival, quality of life, or patient and family satisfaction.

Appropriateness for EHC Program

Does your question include a health care drug, intervention, device, or technology available (or likely to be available) in the U.S.?
Which priority area(s) and population(s) does this topic apply to? (check all that apply)
EHC Priority Conditions (updated in 2008)
  • Cancer
AHRQ Priority Populations
  • Low income groups
  • Minority groups
  • Women
  • Elderly
  • Individuals with special health care needs, including individuals with disabilities or who need chronic care or end-of-life health care
Federal Health Care Program
  • Medicaid
  • Medicare


Describe why this topic is important.
Palliative care provided earlier in the course of disease, with its focus on management of symptoms, psychosocial support, and assistance with decision making, has the potential to have a meaningful effect on patients' quality of life and end-of-life care. Patients with advanced or metastatic disease such as non–small-cell lung cancer have a substantial symptom burden and often receive aggressive care at the end of life. There is significant toxicity associated with aggressive therapy, usually with minimal possibility of benefit from treatment.
What specifically motivated you to ask this question? (For example, you are developing a clinical guideline, working with a policy with large uncertainty about the appropriate approach, costly intervention, new research you have read, items in the media you may have seen, a clinical practice dilemma you know of, etc.)
This topic was given the highest priority by a multi-disciplinary stakeholder panel (including patient advocates/representatives) convened to identify and select research questions on cancer of importance for systematic review.

There is a gap in current knowledge among clinicians and patients on palliative care. There is a need for standardization of approaches used for palliative care, as different sets of interventions and outcome measures are used across research studies to assess its clinical impact. A comprehensive systematic review would synthesize current findings on palliative care and convey that information to clinicians, patients, and other decision makers. It also might suggest which of the approaches used within research studies might be most fruitful for further investigations.
Does your question represent uncertainty for clinicians and/or policy-makers? (For example, variations in clinical care, controversy in what constitutes appropriate clinical care, or a policy decision.)
If yes, please explain:
There currently is uncertainty among both clinicians and patients about the impact of
early introduction of palliative care in terms of survival and improvements in quality of life and mood. A recent study (Temel et al, 2010)* had surprising findings indicating that the use of palliative care might even modestly increase survival. This research has spurred interest in developing a better understanding of the effect of palliative care.

* Temel JS, et al. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. N Engl J Med 2010; 363:733-742.

Potential Impact

How will an answer to your research question be used or help inform decisions for you or your group?
A report would inform clinical decision-making for patients, payers and providers.
Describe the timeframe in which an answer to your question is needed.
Describe any health disparities, inequities, or impact on vulnerable populations your question applies to.
Elderly patients with cancer near the end of life and their caregivers are a particularly vulnerable population. It is reasonable to hypothesize that testing and optimizing ways to integrate palliative care early after diagnosis with advanced or metastatic disease could help alleviate the burden of disease symptoms and adverse effects of treatment. The impact of palliative care on other AHRQ priority populations (e.g., women, minority groups) can also be examined, to the degree that evidence is available.

Nominator Information

Other Information About You: (optional)
Please choose a description that best describes your role or perspective: (you may select more than one category if appropriate)
  • Other
Are you making a suggestion as an individual or on behalf of an organization?
Organization - BlueCross BlueShield Association Technology Evaluation Center
Please tell us how you heard about the Effective Health Care Program
The BlueCross BlueShield Association Technology Evaluation Center is an Evidence-based Practice Center of AHRQ.