Stepped Palliative Care Versus Early Integrated Palliative Care in Patients With Advanced Lung Cancer

Patients with serious cancers, like advanced lung cancer, often experience physical symptoms,
such as pain or shortness of breath. In addition, both patients and their loved ones (family
and friends) often feel worried or sad about their cancer diagnosis.

Research has shown that early involvement of a team of clinicians that specialize in
lessening (or "palliating") many of these distressing physical and emotional symptoms and in
helping patients and their family cope with a serious illness improves patients' and their
loved ones' experience with their cancer. This team is called "palliative care," and consists
of physicians and advanced practice nurses (or "nurse practitioners") who work closely and
collaboratively with your oncology team to care for the participant and the participant's
loved ones. Research shows that when the palliative care team works closely with the oncology
team to care for patients with advanced cancer, they may have better symptom control, quality
of life, and mood and their loved ones feel less distressed.

This study will compare two different strategies for scheduling participant's visits with the
palliative care clinician. The first strategy is to schedule the participant to meet with the
palliative care clinician regularly each month. The investigators call this strategy "early
integrated palliative care".

The second strategy is to schedule the participant to meet with the palliative care clinician
after the participant is admitted to the hospital or if the participant's oncology team needs
to change the participant cancer treatment, as these are times when the participant is likely
to have health issues that the palliative care clinician can help with. The investigators
will also monitor the participant's quality of life regularly. If the study team determines
that the participant quality of life worsens, the investigators will increase the frequency
of the participant's visits with the palliative care clinician to monthly appointments. The
investigators call this strategy "stepped palliative care" because the investigators step up
the frequency of the participant palliative care visits if the participant's quality of life
worsens during the participant cancer treatment.

No matter which strategy the participant is taking part in, the participant will still be
able to request additional palliative care visits outside of the study schedule if the
participant feel they need them.

Inclusion Criteria:

- Diagnosed with advanced non-small cell lung cancer, small cell lung cancer, or
mesothelioma, being treated with non-curative intent, and informed of advanced disease
within the prior eight weeks

- Eastern Cooperative Oncology Group (ECOG) Performance Status from 0 (asymptomatic) to
2 (symptomatic and in bed <50% of the day)

- The ability to read and respond to questions in English or Spanish

- Primary cancer care at one of the three participating sites

- Age > 18 years

Exclusion Criteria:

- Already receiving PC or hospice services

- Cognitive or psychiatric conditions as determined by the treating oncologist to
prohibit study consent or participation