title: Aggressiveness of care in a prospective cohort of patients with advanced NSCLC.
abstract: BACKGROUND
  Optimal end of life care of patients with terminal cancer is poorly understood. In this study, the aggressiveness of care is described in a cohort of patients with newly diagnosed advanced nonsmall-cell lung cancer (NSCLC).
  
  
  METHODS
  Patients within 8 weeks of diagnosis of stage IIIb (with effusions) or IV NSCLC were enrolled in a study to examine the feasibility of involving palliative care services early in the provision of cancer care. Participants received standard oncology treatment and integrated palliative care. All patients were followed prospectively to assess anticancer therapy usage, hospital admissions, hospice utilization, and location of death.
  
  
  RESULTS
  At the time of analysis, 40/46 (87%) of enrolled patients had died, with a median length of follow-up of 29.3 months. Aggressive care measures in the final month of life included rates of anticancer therapy (40%), emergency department visits (48%), and hospital admissions (50%). Sixty-five percent of patients received hospice care before death, with a median length of stay of 16 days. Patients with heightened baseline anxiety and mood symptoms were more likely to receive anticancer therapy at the end of life compared with those without such symptoms.
  
  
  CONCLUSIONS
  This study demonstrates the frequent use of aggressive measures at the end of life among patients with advanced NSCLC in a tertiary care center, as shown by the number of patients receiving anticancer therapy within 30 days of death and brief utilization of hospice services. Further research is needed to identify predictors of aggressive care and to develop interventions enhancing decision-making at the end of life.
authors.affiliation: Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. jtemel@partners.org
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Temel
authors.forename: Jessica
authors.initials: J
authors.lastname: McCannon
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Greer
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Jackson
authors.forename: Patricia
authors.initials: P
authors.lastname: Ostler
authors.forename: William F
authors.initials: WF
authors.lastname: Pirl
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Lynch
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Billings
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D002289:Carcinoma, Non-Small-Cell Lung / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D017051:Hospice Care / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D013727:Terminal Care
chemical_list: D000970:Antineoplastic Agents