TY - JOUR
T1 - Metastatic non-small cell lung cancer: a benchmark for quality end-of-life cancer care?
AU - Philip, Jennifer
AU - Hudson, Peter
AU - Bostanci, Adam
AU - Street, Annette
AU - Horey, Dell E
AU - Aranda, Sanchia
AU - Zordan, Rachel
AU - Rumbold, Bruce D
AU - Moore, Gaye
AU - Sundararajan, Vijaya
PY - 2015
Y1 - 2015
N2 - Objectives: To investigate the quality of end-of-life care for patients with
metastatic non-small cell lung cancer (NSCLC). Design and participants: Retrospective cohort study of patients from
first hospitalisation for metastatic disease until death, using hospital,
emergency department and death registration data from Victoria, Australia,
between 1 July 2003 and 30 June 2010. Main outcome measures: Emergency department and hospital use;
aggressiveness of care including intensive care and chemotherapy in last 30
days; palliative and supportive care provision; and place of death. Results: Metastatic NSCLC patients underwent limited aggressive
treatment such as intensive care (5%) and chemotherapy (< 1%) at the
end of life; however, high numbers died in acute hospitals (42%) and
61% had a length of stay of greater than 14 days in the last month of life.
Although 62% were referred to palliative care services, this occurred late
in the illness. In a logistic regression model adjusted for year of metastasis,
age, sex, metastatic site and survival, the odds ratio (OR) of dying in an
acute hospital bed compared with death at home or in a hospice unit
decreased with receipt of palliative care (OR, 0.25; 95% CI, 0.21–0.30) and
multimodality supportive care (OR, 0.65; 95% CI, 0.56–0.75).
Conclusion: Because early palliative care for patients with metastatic
NSCLC is recommended, we propose that this group be considered a
benchmark of quality end-of-life care. Future work is required to determine
appropriate quality-of-care targets in this and other cancer patient cohorts,
with particular focus on the timeliness of palliative care engagement.
AB - Objectives: To investigate the quality of end-of-life care for patients with
metastatic non-small cell lung cancer (NSCLC). Design and participants: Retrospective cohort study of patients from
first hospitalisation for metastatic disease until death, using hospital,
emergency department and death registration data from Victoria, Australia,
between 1 July 2003 and 30 June 2010. Main outcome measures: Emergency department and hospital use;
aggressiveness of care including intensive care and chemotherapy in last 30
days; palliative and supportive care provision; and place of death. Results: Metastatic NSCLC patients underwent limited aggressive
treatment such as intensive care (5%) and chemotherapy (< 1%) at the
end of life; however, high numbers died in acute hospitals (42%) and
61% had a length of stay of greater than 14 days in the last month of life.
Although 62% were referred to palliative care services, this occurred late
in the illness. In a logistic regression model adjusted for year of metastasis,
age, sex, metastatic site and survival, the odds ratio (OR) of dying in an
acute hospital bed compared with death at home or in a hospice unit
decreased with receipt of palliative care (OR, 0.25; 95% CI, 0.21–0.30) and
multimodality supportive care (OR, 0.65; 95% CI, 0.56–0.75).
Conclusion: Because early palliative care for patients with metastatic
NSCLC is recommended, we propose that this group be considered a
benchmark of quality end-of-life care. Future work is required to determine
appropriate quality-of-care targets in this and other cancer patient cohorts,
with particular focus on the timeliness of palliative care engagement.
U2 - 10.5694/mja14.00579
DO - 10.5694/mja14.00579
M3 - Article
SN - 0025-729X
VL - 202
SP - 139
EP - 143
JO - Medical Journal of Australia
JF - Medical Journal of Australia
IS - 3
ER -