Kikuo Nakano1, Takashi Yoshida, Junko Furutama, Shoji Sunada. 1. Department of Respiratory Medicine, National Hospital Organization, Kure Medical Center, 3-1 Aoyama, Kure, Hiroshima 737-0023, Japan. knakano@kure-nh.go.jp
Abstract
PURPOSE: Patients with lung cancer in Japan often receive aggressive care near the end of life and die in an acute care hospital. We describe the differences in end-of-life care for metastatic non-small-cell lung cancer (NSCLC) patients between general wards and a palliative care unit (PCU). METHODS: A retrospective analysis was conducted using data from patients who received at least second-line chemotherapy between 2002 and 2007 in a single institute. Among 72 eligible patients, we categorised patients into two groups, those who died in general wards (n = 57) and those who died in the PCU (n = 15), and examined end-of-life care including chemotherapy, do-not-resuscitate (DNR) decision making and treatment in the last 48 h of life. RESULTS: Mean number of days between the last chemotherapy and death was shorter in general wards than in the PCU (P = 0.019). Furthermore, 25% of patients in general wards received chemotherapy within the last 2 weeks of life. Rates of multiple hospitalisations in the last month of life appeared higher in general wards than in the PCU. Mean number of days between documentation of DNR and death was shorter in general wards than in the PCU (P = 0.0010). Patients in general wards received a greater volume of hydration than those in the PCU (P < 0.001). CONCLUSIONS: Patients with metastatic NSCLC in general wards receive inappropriate care near the end of life. Further studies are needed to develop interventions for making decisions regarding end-of-life care.
PURPOSE:Patients with lung cancer in Japan often receive aggressive care near the end of life and die in an acute care hospital. We describe the differences in end-of-life care for metastatic non-small-cell lung cancer (NSCLC) patients between general wards and a palliative care unit (PCU). METHODS: A retrospective analysis was conducted using data from patients who received at least second-line chemotherapy between 2002 and 2007 in a single institute. Among 72 eligible patients, we categorised patients into two groups, those who died in general wards (n = 57) and those who died in the PCU (n = 15), and examined end-of-life care including chemotherapy, do-not-resuscitate (DNR) decision making and treatment in the last 48 h of life. RESULTS: Mean number of days between the last chemotherapy and death was shorter in general wards than in the PCU (P = 0.019). Furthermore, 25% of patients in general wards received chemotherapy within the last 2 weeks of life. Rates of multiple hospitalisations in the last month of life appeared higher in general wards than in the PCU. Mean number of days between documentation of DNR and death was shorter in general wards than in the PCU (P = 0.0010). Patients in general wards received a greater volume of hydration than those in the PCU (P < 0.001). CONCLUSIONS:Patients with metastatic NSCLC in general wards receive inappropriate care near the end of life. Further studies are needed to develop interventions for making decisions regarding end-of-life care.
Authors: T Morita; I Hyodo; T Yoshimi; M Ikenaga; Y Tamura; A Yoshizawa; A Shimada; T Akechi; M Miyashita; I Adachi Journal: Ann Oncol Date: 2005-01-31 Impact factor: 32.976
Authors: Jennifer S Temel; Jessica McCannon; Joseph A Greer; Vicki A Jackson; Patricia Ostler; William F Pirl; Thomas J Lynch; J Andrew Billings Journal: Cancer Date: 2008-08-15 Impact factor: 6.860
Authors: O P Geerse; D Brandenbarg; H A M Kerstjens; A J Berendsen; S F A Duijts; H Burger; G A Holtman; J E H M Hoekstra-Weebers; T J N Hiltermann Journal: Lung Cancer Date: 2019-02-10 Impact factor: 5.705
Authors: Sema Sezgin Goksu; Seyda Gunduz; Dilek Unal; Mukremin Uysal; Deniz Arslan; Ali M Tatlı; Hakan Bozcuk; Mustafa Ozdogan; Hasan S Coskun Journal: BMC Palliat Care Date: 2014-11-19 Impact factor: 3.234
Authors: Paul R Duberstein; Michael Chen; Michael Hoerger; Ronald M Epstein; Laura M Perry; Sule Yilmaz; Fahad Saeed; Supriya G Mohile; Sally A Norton Journal: J Pain Symptom Manage Date: 2019-10-19 Impact factor: 3.612