François Goldwasser1, Pascale Vinant2, Régis Aubry3, Philippe Rochigneux4, Yvan Beaussant3, Olivier Huillard1, Lucas Morin5. 1. Medical Oncology, Cochin Port-Royal Hospital (Public Hospital System of Paris), Paris Descartes University, Paris, France. 2. Department of Palliative Care, Cochin Port-Royal Hospital (Public Hospital System of Paris), Paris Descartes University, Paris, France. 3. Department of Palliative Care, Besançon University Hospital, Besançon, France. 4. Department of Medical Oncology, Paoli-Calmettes Institute, Marseille, France. 5. Aging Research Center, Karolinska Institute, Stockholm, Sweden.
Abstract
BACKGROUND: Early integration of palliative care for patients with metastatic lung cancer improves their quality of life and survival and reduces the aggressiveness of care near the end of life. This study examined the association between the timing of palliative care needs reporting and the aggressiveness of end-of-life care. METHODS: This retrospective cohort study used the French National Hospital Registry to identify all hospitalized adults (≥20 years old) who died of metastatic lung cancer in France between 2010 and 2013. It compared the use of care and treatments near the end of life as a function of the timing of the first reporting of palliative care needs. The use of chemotherapy and the use of invasive ventilation were defined as primary outcomes. Propensity score weighting was used to control for potential confounders. RESULTS: Among a total of 64,950 deceased patients with metastatic lung cancer, the reporting of palliative care needs was characterized as timely (from 91 to 31 days before death) for 26.3%, late (from 30 to 8 days before death) for 31.5%, and very late (from 7 to 0 days before death) for 12.8%. Palliative care needs were not reported for 19,106 patients (29.4%). Patients with timely reporting of palliative care needs had the earliest and most progressive decrease in the use of anticancer therapy. The use of invasive ventilation also increased with a delay in palliative care needs reporting. CONCLUSIONS: There is a clear association between the timing of palliative care needs reporting and the aggressiveness of care near the end of life. Cancer 2018;124:3044-51.
BACKGROUND: Early integration of palliative care for patients with metastatic lung cancer improves their quality of life and survival and reduces the aggressiveness of care near the end of life. This study examined the association between the timing of palliative care needs reporting and the aggressiveness of end-of-life care. METHODS: This retrospective cohort study used the French National Hospital Registry to identify all hospitalized adults (≥20 years old) who died of metastatic lung cancer in France between 2010 and 2013. It compared the use of care and treatments near the end of life as a function of the timing of the first reporting of palliative care needs. The use of chemotherapy and the use of invasive ventilation were defined as primary outcomes. Propensity score weighting was used to control for potential confounders. RESULTS: Among a total of 64,950 deceased patients with metastatic lung cancer, the reporting of palliative care needs was characterized as timely (from 91 to 31 days before death) for 26.3%, late (from 30 to 8 days before death) for 31.5%, and very late (from 7 to 0 days before death) for 12.8%. Palliative care needs were not reported for 19,106 patients (29.4%). Patients with timely reporting of palliative care needs had the earliest and most progressive decrease in the use of anticancer therapy. The use of invasive ventilation also increased with a delay in palliative care needs reporting. CONCLUSIONS: There is a clear association between the timing of palliative care needs reporting and the aggressiveness of care near the end of life. Cancer 2018;124:3044-51.
Authors: Mary-Joanne Verhoef; Ellen J M de Nijs; Claudia S Ootjers; Marta Fiocco; Anne J Fogteloo; Christian Heringhaus; Corrie A M Marijnen; Nanda Horeweg; Yvette M van der Linden Journal: Am J Hosp Palliat Care Date: 2019-12-23 Impact factor: 2.500