Impact of early palliative care on patients with advanced lung cancer: a retrospective real- world cohort study using the TriNetX network

Background Patients with advanced lung cancer often experience severe and life-threatening symptoms, particularly respiratory distress. Early palliative care (PC) has been shown to alleviate symptom burden and reduce health-care utilization; however, the optimal timing of early PC remains inconsistently defined. This study aimed to evaluate the impact of early PC on clinical outcomes using an international real-world database. Methods We conducted a retrospective cohort analysis of patients with advanced lung cancer identified from the TriNetX real-world database from January 1, 2012, to December 31, 2022. Early PC was defined as PC initiation within three months after advanced lung cancer diagnosis. Clinical outcomes, including medication, symptoms, respiratory conditions, invasive procedure, and mortality, were compared between early and no PC cohorts using propensity score matching and Chi-square test. Results A total of 48,450 eligible patients was identified; 35,350 (73%) received early PC. After matching, 13,100 patients were included in each cohort. Early PC was associated with higher morphine use but lower depression. These findings indicate that although early PC cohort exhibited higher early-phase mortality and acute respiratory conditions, they subsequently experienced fewer invasive procedures and late deaths over time, suggesting potential benefits from timely PC integration. Conclusions Early integration of palliative care can improve symptom management and reduce invasive procedures, even in the presence of higher early mortality. These findings highlight the importance of timely PC referral for patients newly diagnosed with advanced lung cancer.