Aggressiveness of care in a prospective cohort of patients with advanced NSCLC.
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.
Temel
Jennifer S
JS
Department of Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. jtemel@partners.org
McCannon
Jessica
J
Greer
Joseph A
JA
Jackson
Vicki A
VA
Ostler
Patricia
P
Pirl
William F
WF
Lynch
Thomas J
TJ
Billings
J Andrew
JA
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
D000970:Antineoplastic Agents