# Temel: early palliative care alongside chemotherapy improved quality of life, mood and survival in lung cancer

Source: https://onco.cc/key-papers/paper-temel-early-palliative-care-nejm-2010/  
OnCo record `paper-temel-early-palliative-care-nejm-2010` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Patients newly diagnosed with metastatic lung cancer who saw a palliative care team from diagnosis had better quality of life, less depression, less aggressive end-of-life care and lived a median 2.7 months longer than those receiving oncology care alone.

## Summary

At Massachusetts General Hospital, 151 patients with newly diagnosed metastatic non-small-cell lung cancer were randomised to early palliative care integrated with standard oncology care (monthly visits with a palliative care clinician) or to standard oncology care with palliative care only on request.

The primary endpoint, change in quality of life at 12 weeks (FACT-L), favoured early palliative care (98.0 vs 91.5). Fewer patients had depressive symptoms (16% vs 38%), fewer received aggressive end-of-life care (33% vs 54%), and median survival was 11.6 versus 8.9 months.

The survival signal overturned the assumption that palliative care shortens life and led ASCO to recommend concurrent palliative care for all patients with metastatic cancer from diagnosis.

## Fields

- Kind: Key paper
- Last checked: 2026-09-08
- Journal: New England Journal of Medicine
- Year: 2010
- DOI: 10.1056/NEJMoa1000678
- Authors: Temel JS, Greer JA, Muzikansky A, et al.
- Findings: Quality of life at 12 weeks: FACT-L 98.0 vs 91.5 (p = 0.03); Depressive symptoms 16% vs 38% (p = 0.01); Aggressive end-of-life care 33% vs 54%; more patients documented resuscitation preferences; Median overall survival 11.6 vs 8.9 months (p = 0.02) despite less chemotherapy near death
- What it means: Palliative care is not what happens when treatment stops; it works best alongside cancer treatment from the start. Patients feel better, are less depressed and may live longer. Access remains the constraint: most of the world's patients never see a palliative care specialist.
- Caveats: Single centre, unblinded, and survival was not the primary endpoint; later trials showed mixed survival effects; Small sample; the survival difference was not confirmed in the larger 2017 Temel trial across cancers; Requires trained palliative care workforce that most health systems lack; Mechanism (symptom control, less futile chemotherapy, better decision-making) remains debated

## Sources

- DOI: https://doi.org/10.1056/NEJMoa1000678
- ClinicalTrials.gov NCT01038271: https://clinicaltrials.gov/study/NCT01038271

## Connected records

- technologies: [Early integrated palliative care](https://onco.cc/technologies/palliative-care/), [Electronic patient-reported outcome (ePRO) symptom monitoring](https://onco.cc/technologies/epro-symptom-monitoring/), [Hospice and end-of-life care](https://onco.cc/technologies/hospice-end-of-life/)
- ideas: [Automatic palliative care referral triggered by diagnosis, not by decline](https://onco.cc/ideas/idea-acc-automatic-early-palliative-triggers/), [Palliative care from diagnosis for every advanced cancer, including opioid access, worldwide](https://onco.cc/ideas/idea-moon-palliative-care-from-diagnosis-everywhere/), [Video palliative care as an equivalent default option for patients far from a team](https://onco.cc/ideas/idea-acc-tele-palliative-care-default/)
- cancers: [Non-small-cell lung cancer](https://onco.cc/cancers/nsclc/)
- fronts: [Supportive Care & Survivorship](https://onco.cc/fronts/supportive-care/)
- institutions: [Massachusetts General Hospital Cancer Center](https://onco.cc/institutions/mgh/)
- bottlenecks: [Not enough oncologists, nurses, pathologists, physicists](https://onco.cc/bottlenecks/b-workforce/), [Pain relief and palliative care are unavailable to most](https://onco.cc/bottlenecks/b-palliative/), [Toxicity and quality of life are undervalued](https://onco.cc/bottlenecks/b-toxicity-qol/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)
- people: [Jennifer S. Temel](https://onco.cc/people/jennifer-temel/)

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