Original Article
End-of-Life Care in Lung Cancer Patients in Ontario: Aggressiveness of Care in the Population and a Description of Hospital Admissions

https://doi.org/10.1016/j.jpainsymman.2007.04.019Get rights and content
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Abstract

The purpose of this study was to describe (1) the aggressiveness of care in a population of patients who die of lung cancer and (2) differences in care between a sample of lung cancer patients who died in an acute care hospital (DH) and a sample of lung cancer patients who were admitted to hospital during the last six months of life but were discharged and died elsewhere (DO). All lung cancer deaths in 2002 were identified in the provincial registry. Cases were linked to administrative sources of health care data to describe the population as a whole and the aggressiveness of the care that they received. Primary data were collected from a province-wide sample of patients' hospital charts focusing on reasons for admission, care in hospital, advanced planning, pain, and disposition. In total, 5,855 patients who died of lung cancer in 2002 were eligible for inclusion in the cohort. Rates of in-hospital death, emergency room visits, intensive care unit admissions, and chemotherapy use near the end of life were 59.5%, 32.2%, 5.5%, and 4.6%, respectively. The records of 491 patients were abstracted for this study. The DH and DO groups were similar with respect to age, gender, neighborhood income level, and extent of metastatic disease. The most common chief complaints were shortness of breath, pain, inability to cope at home, and altered level of consciousness. Compared to patients in the DO group, those in the DH group presented with pain more often (19% vs. 10%, P < 0.005) and were more likely to be admitted with progressive chest malignancy (30% vs. 21%, P < 0.05). Regardless of reason for admission, pain was commonly documented as a problem during admission: 73.5% in the DH group and 62.4% in the DO group (P < 0.05). Lung cancer patients are heavy users of acute care beds and the emergency room at the end of life. Those who do or do not die in hospital are similar in many respects but our results suggest those dying in hospital have more problems with pain and burden from local chest malignancy.

Key Words

Lung cancer
end-of-life care
in-hospital death

Cited by (0)

There are no conflicts of interest between the above authors and the material of this manuscript.

Preliminary results of this research were presented in 2006 at the meeting of the Multinational Association of Supportive Care in Cancer (MASCC) and the World Cancer Congress of the International Union Against Cancer (UICC).

Dr. Barbera is an Ontario Ministry of Health and Long-Term Care Career Scientist. This research was supported by a grant from the Canadian Institute for Health Research.