Breathlessness, Functional Status, Distress, and Palliative Care Needs Over Time in Patients With Advanced Chronic Obstructive Pulmonary Disease or Lung Cancer: A Cohort Study

Weingaertner, Vera; Scheve, Christian von; Gerdes, V; Schwarz-Eywill, M; Prenzel, R; Bausewein, Claudia; Higginson, Irene J; Voltz, Raymond; Herich, Lena; Simon, Steffen T.; Kannenberg-Otremba, B.; Sowinsky, Nicole; Otremba, Burkhard; Jüptner, Alexander; Meyer, Jochen; Cortis, Julia; Mühlenbrock, Juliane; Wagner-Neidig, Andreas; Hein, Andreas; Reichert, Dietmar; Jessen, Marion; Frenken, Melina; Frenken, Thomas

doi:10.1016/j.jpainsymman.2013.11.011

Cited by 97 publications

(87 citation statements)

References 32 publications

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“…Conversely, research literature provides ample evidence that lung cancer and COPD are a common combination [28] and that the suffering of patients with COPD is comparable to that of patients with cancer [29]. Patients with advanced COPD experience similar deterioration in symptoms and quality of life as those with advanced malignancy [30].…”

Section: Discussionmentioning

confidence: 99%

Palliative care needs in COPD patients with or without cancer: an epidemiological study

Meffert

Hatami²,

Xander

et al. 2015

Eur Respir J

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Chronic obstructive pulmonary disease (COPD) is a growing cause of morbidity and mortality worldwide. However, many patients with severe COPD do not receive adequate palliative care. The main goals of our study were to identify the percentage of hospital patients with palliative care needs, particularly those who suffer from COPD.Data were collected prospectively from inpatients at the University Medical Centre Freiburg (Freiburg, Germany). Based on the World Health Organization definition of palliative care, the treating physician reported for each patient discharged whether the patient had palliative care needs or not. Data from 39 849 patients could be analysed, of which 1455 were suffering from COPD.Of all COPD patients, 9.1% had palliative care needs. In COPD patients with palliative care needs, hospital stay was significantly longer (13.7 versus 10.3 days) than in the group without palliative care needs, and significantly more patients died during their hospital stay (8.3% versus 3.7%). The presence of metastases was the highest risk factor for developing palliative care needs (OR 4.18). Furthermore, a main diagnosis of COPD implied an increased probability of palliative care needs (OR 1.87).Our results show that COPD patients have a high risk of developing palliative care needs. Further efforts are required to provide palliative care to COPD patients. @ERSpublicationsPatients with COPD as a main diagnosis or a comorbid condition have a high risk of developing palliative care needs

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Section: Discussionmentioning

confidence: 99%

Palliative care needs in COPD patients with or without cancer: an epidemiological study

Meffert

Hatami²,

Xander

et al. 2015

Eur Respir J

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“…Patients with COPD often do not achieve adequate relief of dyspnea and live in fear of suffocation in the last 6 months of life (1). In fact, patients with COPD may experience more severe dyspnea and poorer functional status during a longer and more protracted course of illness than patients with lung cancer (29). Although patients with chronic lung disease face as much, or in some cases more, symptom burden, longer hospital stays, and lower levels of satisfaction of care than patients with cancer (29-32), few discuss their treatment preferences with their physicians or implement advance care planning (7,33,34).…”

Section: Original Researchmentioning

confidence: 99%

Palliative Care for Patients Dying in the Intensive Care Unit with Chronic Lung Disease Compared with Metastatic Cancer

et al. 2016

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Rationale: Palliative care has been focused largely on patients with cancer, and yet patients with chronic lung diseases also have high morbidity and mortality. The majority of deaths in intensive care units (ICUs) follow decisions to withhold or withdraw life-sustaining treatments, suggesting that palliative care is critically important in this setting.Objectives: We explored differences in receipt of elements of palliative care among patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) who die in ICUs compared with patients with cancer.Methods: We identified patients with COPD, ILD, or metastatic cancer who died in the ICUs of 15 Seattle-area hospitals between 2003 and 2008. We used robust multivariable logistic and linear regression to compare differences in receipt of elements of palliative care and length of stay. Measurements and Main Results:Compared with patients with cancer, patients with COPD were more likely to receive cardiopulmonary resuscitation before death and patients with ILD were less likely to have documentation of pain assessment in the last day of life. Patients with ILD and COPD were less likely to have a do-not-resuscitate order in place at the time of death and less likely to have documentation of discussions about prognosis than patients with cancer. Patients with COPD had longer hospital lengths of stay, and patients with COPD and ILD had longer ICU lengths of stay. Conclusions:Among patients who die in the ICU, patients with ILD and COPD receive fewer elements of palliative care and have longer lengths of stay than patients with cancer. These findings identify areas for improvement in caring for patients with chronic lung diseases.Clinical trial registered with www.clinicaltrials.gov (NCT00685893).

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“…The majority of studies published focussed on patients with COPD (n=24) 4, in addition to multi-disease diagnoses studies (n=10) 1,5,[30][31][32][33][34][35][36][37] where the majority of patients in the study sample had a diagnosis of COPD. Patients with cancer diagnoses were the next studied population of focus (n=13), [38][39][40][41][42][43][44][45][46][47][48][49][50] followed by patients with interstitial lung disease (n=8), [51][52][53][54][55][56][57][58] and lastly one study focussed on patients with Huntington's disease (Table 1) Page S35…”

Section: Resultsmentioning

confidence: 99%

“…10,16 Patients with COPD also report higher perceived breathlessness and report experiencing severe to very severe breathlessness over the past 24 hours at a rate 3 times higher as compared to patients with lung cancer receiving palliative care. 37 Severity of perceived breathlessness was also correlated with more palliative care needs in persons with COPD but not for those with lung cancer. 37 It is therefore ideal to refer patients with COPD to pulmonary rehabilitation and palliative care as soon as they become symptomatic.…”

Section: Chronic Obstructive Pulmonary Disease (Copd)mentioning

confidence: 95%

A Review of Non-Pharmacological Pulmonary Rehabilitation for Patients Receiving Palliative Care

Dawson¹,

Freeman²,

Adam³

2017

Pulm Res Respir Med Open J

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Introduction: Dyspnea is common in patients experiencing chronic and malignant lung conditions. It is a very distressing symptom that often results in anxiety and depression. Pulmonary rehabilitation together with palliative care can provide physical, psychological, and quality of life (QoL) improvements in patients that receive it. Methods: This literature review examined articles published in the last 5 years to give a current summary of the scientific literature regarding pulmonary rehabilitation for persons receiving palliative care treatment. Focus was placed on patients with chronic obstructive pulmonary disease, cancer, interstitial lung disease, and Huntington's disease. From an initial 218 articles, 56 met the inclusion criteria for this review. Results: Prominent themes that emerged were the beneficial effects of pulmonary rehabilitation, even in late stages of lung disease, and the positive impact palliative care can have on the patient. Simultaneously, there were considerable barriers to access mentioned throughout the literature, which prevents patients from receiving either pulmonary rehabilitation and/or palliative care at the end-of life. Educating health care providers on the benefits of pulmonary rehabilitation, and providing timely referrals to pulmonary rehabilitation and palliative care is important. Understanding factors which may prompt a patient to attend and complete, or discontinue, pulmonary rehabilitation treatment is important. Conclusion: Although, pulmonary rehabilitation itself is beneficial, meeting the patient where they are at and pairing rehabilitation with patient empowerment and motivating therapies such as mindfulness-based therapy may improve the patient's QoL and care at the end-of-life. Most pulmonary rehabilitation programs are focused and tailored to patients with chronic obstructive pulmonary disease. Exploring how tailored pulmonary rehabilitation programs may be effective in other populations, such as patients with interstitial lung disease, Huntington's disease, and end-stage cancer, is warranted.

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Breathlessness, Functional Status, Distress, and Palliative Care Needs Over Time in Patients With Advanced Chronic Obstructive Pulmonary Disease or Lung Cancer: A Cohort Study

Abstract: The PC needs of patients with advanced COPD are comparable with LC patients, and breathlessness severity and distress are even higher. The care for COPD patients requires further improvement to address symptom burden and PC needs.

Cited by 97 publications

References 32 publications

Palliative care needs in COPD patients with or without cancer: an epidemiological study

Palliative care needs in COPD patients with or without cancer: an epidemiological study

Palliative Care for Patients Dying in the Intensive Care Unit with Chronic Lung Disease Compared with Metastatic Cancer

A Review of Non-Pharmacological Pulmonary Rehabilitation for Patients Receiving Palliative Care

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