Early bird special.

By now, you shouldn’t be surprised to hear that there’s a large VA population study that shows integrating palliative care for patients not eminently dying of advanced lung cancer is associated with improved survival. A unique strength of the VA study, though, is that it looks at the largest integrated healthcare system in the US. Perhaps most interesting is the figure showing palliative care utilization by VA facility, which ranged from as low as 5% of patients to as high as 95%. While there is definite regional variation, there are also stark differences in palliative care utilization across VA facilities within regions. While we don’t doubt the benefits of early palliative care, this study got us to wondering whether the very integration of palliative care is a signal for better guideline-adherent care overall. TBL: Early integrated palliative care should still be the go-to for patients with terminal metastatic disease. | Sullivan, JAMA Oncol 2019