<p>End-of-life care in individuals with respiratory diseases: a population study comparing the dying experience between those with chronic obstructive pulmonary disease and lung cancer</p>

Abstract

Purpose Among individuals with COPD and/or lung cancer, to describe end-of-life health service utilization, costs, and place of death; to identify predictors of home palliative care use, and to assess benefits associated with palliative care use. Patients and methods We conducted a retrospective population-based study using provincial linked health administrative data (Ontario, Canada) between 2010 and 2015. We examined health care use in the last 90 days of life in adults 35 years and older with physician-diagnosed COPD and/or lung cancer identified using a validated algorithm and the Ontario Cancer Registry, respectively. Four mutually exclusive groups were considered: (i) COPD only, (ii) lung cancer only, (iii) COPD and lung cancer, and (iv) neither COPD nor lung cancer. Multivariable generalized linear models were employed. Results Of 445,488 eligible deaths, 34% had COPD only, 4% had lung cancer only, 5% had both and 57% had neither. Individuals with COPD only received less palliative care (20% vs 57%) than those with lung cancer only. After adjustment, people with lung cancer only were far more likely to receive palliative care (OR=4.22, 4.08–4.37) compared to those with neither diagnosis, while individuals with COPD only were less likely to receive palliative care (OR=0.82, 0.81–0.84). Home palliative care use was associated with reduced death and fewer days in acute care, and less cost, regardless of the diagnosis. Conclusion Although individuals with lung cancer were much more likely to receive palliative care than those with COPD, both populations were underserviced. Results suggest greater involvement of palliative care may improve the dying experience of these populations and reduce costs.

Comparison of end-of-life care in people with chronic obstructive pulmonary disease or lung cancer: A systematic review

“…26–28 Two studies compared a population with COPD to a population with both lung cancer and co-existing COPD with one retrospective 29 and one prospective design. 30 Three studies 10,31,32 compared across three disease groups: COPD, lung cancer, both COPD and lung cancer. All three studies were retrospective and utilized health administrative data.…”

Chronic obstructive pulmonary disease and lung cancer: access to palliative care, emergency room visits and hospital deaths

“…Considering the effectiveness of SPC for symptom control and generalized support [ 16 ] and the documented positive outcomes for patients with COPD [ 17 ], it is reasonable to assume that both LC and COPD patients would be candidates for SPC. Butler et al recently reviewed comparative studies on COPD and LC [ 4 ], however, 10 of the 20 studies reviewed were based on data collected more than 10 years earlier and, among the more recent studies, only two included 1000 or more patients [ 18 , 19 ]. For this reason, we aimed to conduct a large study using recent data, as inclusion criteria for admission to palliative care services for non-malignant conditions such as COPD are changing rapidly.…”

Ten minutes to midnight: a narrative inquiry of people living with dying with advanced copd and their family members

“…Despite availability of staging criteria, it is not always clear when someone with COPD is approaching EOL (Braço Forte & Sousa, 2017 ). Further, people with end stage COPD are far less likely to obtain palliative care than people with the same symptoms and illness profile with lung cancer (Butler et al, 2020 ; Kendzerska et al, 2019 ). Over the past decade, there has been increased recognition that health professionals need to develop better approaches for management of people suffering from advanced COPD.…”

“…A deeper understanding of the experiences of people with COPD and their family caregivers can lead to better EOL care, which is especially important given the limited resources for non-cancer related EOL care (Lilly & Senderovich, 2016 ). In one population-based study in Ontario, Canada, people with COPD were found to be far less likely to receive palliative care than a sample of people with lung cancer (Kendzerska et al, 2019 ). The researchers found palliative care to be associated with fewer deaths in the acute care setting, fewer days in acute care, and less cost, regardless of whether the diagnosis was lung cancer or COPD (Kendzerska et al, 2019 ).…”

“…In one population-based study in Ontario, Canada, people with COPD were found to be far less likely to receive palliative care than a sample of people with lung cancer (Kendzerska et al, 2019 ). The researchers found palliative care to be associated with fewer deaths in the acute care setting, fewer days in acute care, and less cost, regardless of whether the diagnosis was lung cancer or COPD (Kendzerska et al, 2019 ). Iyer et al ( 2020 ), in a qualitative study of pulmonary and palliative care specialists, found that both groups of physicians agreed that early palliative care could have benefits for people with advanced COPD but that the pulmonary specialists had concerns about the risks of use of opioids and benzodiazepines.…”