Zainab Ahmadi1, Nicholas G Wysham2, Staffan Lundström3, Christer Janson4, David C Currow5, Magnus Ekström6. 1. Division of Respiratory Medicine & Allergology, Department of Clinical Sciences, Lund University Hospital, Lund, Sweden. 2. Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Duke University, Center for Learning Health Care, Duke Clinical Research Institute, Durham, North Carolina, USA. 3. Palliative Care Services, Stockholms Sjukhem Foundation, Stockholm, Sweden. 4. Department of Medical Sciences, Respiratory Medicine & Allergology, Uppsala University, Uppsala, Sweden. 5. Department of Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia. 6. Division of Respiratory Medicine & Allergology, Department of Clinical Sciences, Lund University Hospital, Lund, Sweden Department of Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia, Australia.
Abstract
RATIONALE: Advanced fibrosing interstitial lung disease (ILD) is often progressive and associated with a high burden of symptoms and poor prognosis. Little is known about the symptom prevalence and access to palliative care services at end of life (EOL). OBJECTIVES: Compare prevalence of symptoms and palliative treatments between patients dying with oxygen-dependent ILD and patients dying of lung cancer. METHODS: Nationwide registry-based cohort study of patients with oxygen-dependent ILD and patients with lung cancer who died between 1 January 2011 and 14 October 2013. Prevalence of symptoms and treatments during the last seven days of life were compared using data in Swedish Registry of Palliative Care. MEASUREMENTS AND MAIN RESULTS: 285 patients with ILD and 10 822 with lung cancer were included. In ILD, death was more likely to be 'unexpected' (15% vs 4%), less likely to occur in a palliative care setting (17% vs 40%) and EOL discussions with the patients (41% vs 59%) were less common than in lung cancer. Patients with ILD suffered more from breathlessness (75% vs 42%) while patients with lung cancer had more pain (51% vs 73%) (p<0.005 for all comparisons). Patients with ILD had more unrelieved breathlessness, pain and anxiety. The survival time from initiation of oxygen therapy in ILD was a median 8.4 months (IQR 3.4-19.2 months). CONCLUSIONS: Patients with ILD receive poorer access to specialist EOL care services and experience more breathlessness than patients with lung cancer. This study highlights the need of better EOL care in oxygen-dependent ILD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
RATIONALE: Advanced fibrosing interstitial lung disease (ILD) is often progressive and associated with a high burden of symptoms and poor prognosis. Little is known about the symptom prevalence and access to palliative care services at end of life (EOL). OBJECTIVES: Compare prevalence of symptoms and palliative treatments between patients dying with oxygen-dependent ILD and patients dying of lung cancer. METHODS: Nationwide registry-based cohort study of patients with oxygen-dependent ILD and patients with lung cancer who died between 1 January 2011 and 14 October 2013. Prevalence of symptoms and treatments during the last seven days of life were compared using data in Swedish Registry of Palliative Care. MEASUREMENTS AND MAIN RESULTS: 285 patients with ILD and 10 822 with lung cancer were included. In ILD, death was more likely to be 'unexpected' (15% vs 4%), less likely to occur in a palliative care setting (17% vs 40%) and EOL discussions with the patients (41% vs 59%) were less common than in lung cancer. Patients with ILD suffered more from breathlessness (75% vs 42%) while patients with lung cancer had more pain (51% vs 73%) (p<0.005 for all comparisons). Patients with ILD had more unrelieved breathlessness, pain and anxiety. The survival time from initiation of oxygen therapy in ILD was a median 8.4 months (IQR 3.4-19.2 months). CONCLUSIONS:Patients with ILD receive poorer access to specialist EOL care services and experience more breathlessness than patients with lung cancer. This study highlights the need of better EOL care in oxygen-dependent ILD. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Entities:
Keywords:
Idiopathic pulmonary fibrosis; Interstitial Fibrosis; Long Term Oxygen Therapy (LTOT); Lung Cancer; Palliative Care
Authors: Catharina C Moor; Nelleke C Tak van Jaarsveld; Catherine Owusuaa; Jelle R Miedema; Sara Baart; Carin C D van der Rijt; Marlies S Wijsenbeek Journal: Respiration Date: 2021-05-27 Impact factor: 3.580