Early palliative care has been shown to improve the survival of advanced lung cancer patients. However, most of the clinical studies were performed in the era when systemic treatment options for this disease were limited. Currently, many effective treatment options are available, including targeted therapy and immunotherapy. These novel agents improve the treatment outcomes while having less toxicity compared to conventional chemotherapy. Moreover, medical oncologists are now trained to provide palliative care for patients. This study was designed to demonstrate whether early palliative care provided by the palliative care specialist still improves the quality of life or survival of advanced lung cancer patients compared to standard care provided by the medical oncologist.

Advanced non-small cell lung cancer patients initiating a systemic treatment will be randomized to the early palliative care arm (attending a palliative care clinic once a month during the first three months concurrently with oncology clinic appointment) or the standard care arm (attending oncology clinic only). The patients will be asked to complete the quality of life questionnaires (FACT-L, EQ-5D-5L), mental health questionnaire (PHQ-9), and pain assessment once a month for three months and at the sixth month.

Inclusion Criteria:

• Age at least 18 years old
• Pathologically confirmed advanced non-small cell lung cancer
• Plan to receive systemic treatment for lung cancer within three weeks
• ECOG performance status 0-2 with estimated life expectancy > 24 weeks
• Having at least 4 scores according to Edmonton Symptom Assessment System (ESAS)
• Able to complete the questionnaires

Exclusion Criteria:

• Had received systemic treatment for advanced lung cancer before