Palliative Care in Lung Cancer: A Review

Abstract

Lung cancer patients are at high risk of suffering due to severe and refractory symptoms, concomitant respiratory comorbidity, frequent disease progression, and treatment that can worsen and compromise quality of life. Palliative care (PC) has shown multiple benefits to cancer patients such as better quality of life, higher patient and family satisfaction, improved disease understanding, less symptom burden, fewer depressive symptoms, less aggressive end of life care, and even improved survival with early implementation. For these reasons, multiple societies have recognized PC as an essential component of lung cancer care, and early PC is recommended for patients with metastatic disease or refractory symptoms. Unfortunately, utilization of PC is both low and often near the end of life, increasing risk for suffering. Misconceptions about PC often underlie delayed referral to PC. This review summarizes the literature for utilization of PC in lung cancer and focuses on patient benefits, misconceptions, barriers, and implementation.

Palliative Care Use Among Patients With Solid Cancer Tumors

“…Meanwhile, other studies have shown that patients with lung cancer have the greatest use of palliative care, likely because of their high risk of illness. 4,5 Thus, data have been heterogeneous, and larger studies such as ours are warranted, especially from claims-based databases such as Medicare or private insurance plans. Finally, we found that patients with more advanced cancer stage and grade had higher odds of receiving palliative care compared to patients with less advanced stages and grades for all durations of follow-up.…”

“…1,2 Palliative care has been increasingly recognized as an important part of cancer care 3,4 but remains underutilized and often is provided too near end of life (EOL). 5,6 There is a definite gap in knowledge regarding why palliative care is underutilized in cancer care despite its benefits.…”

“…Studies have shown that palliative care can improve quality of life and reduce depressive symptoms for patients with advanced cancer. 5,7 These studies indicate that patients receiving palliative care are more likely to achieve an improved sense of health, including adequate pain control and better physical function, and are less likely to have mood disorders. The landmark study by Temel and colleagues 8 showed that early integration of palliative care in the management of metastatic non-small cell lung cancer prolonged survival by approximately 2 months and reduced the need for aggressive EOL care.…”

Evaluating the Time to Palliative Care Referrals in Patients With Small-Cell Lung Cancer: A Single-Centre Retrospective Review

“…[24][25][26] Typically, PC is not sought until the disease is at an advanced stage requiring hospitalization or if the patient has uncontrolled symptoms that severely impair their QOL. 27,28 Previous studies have suggested that late referrals to PC are inadequate to alter the quality and delivery of care provided to patients with cancer; thus, several organizations such as the ASCO, National Comprehensive Cancer Network, and European Society of Medical Oncology have issued clinical opinions recommending the use of PC earlier in the course of disease. 19,[29][30][31][32] The importance of early PC and the impetus for the development of these guidelines have been provided by several randomized trials that have provided evidence that patients who received early PC input had improved QOL, reduced intensive care unit admissions, increased time spent at home, longer stay in hospice, and lower overall cost of care and health-care use.…”

The Determinants of Palliative Care Use in Patients With Colorectal Cancer: A National Study

“…[4][5][6] Among patients with colorectal cancer for whom a cure is not achievable (ie, about 80% of all patients with metastatic disease), 7,8 palliative care is reported to be associated with improved patient survival and quality of life. 4,[9][10][11][12] Palliative care has also been reported to decrease the need for expensive acute hospital care in the last few months of life and to decrease the cost of end-of-life care among patients with advanced cancer. [13][14][15][16][17] However, the benefits of palliative care interventions are not exclusive to patients with stage IV colorectal cancer.…”