End-of-life care for hospitalized patients with lung cancer: utilization of a palliative care service.
OBJECTIVE
High symptom burden and hospital mortality among patients with lung cancer argues for early palliative care intervention. Patient characteristics and discharge dispositions in hospitalized patients with lung cancer receiving usual care were compared to those referred to a new palliative care service.


METHODS
A retrospective database review of all lung cancer discharges receiving usual care (UC) and palliative care service (PCS) consultation was conducted. Demographics, length of stay, discharge disposition, and mortality were described and compared. Palliative Performance Scale scores were described according to discharge disposition in the PCS group. Disposition of all patients receiving either chemotherapy or surgery was also noted.


RESULTS
A total of 1476 hospital discharges with a diagnosis of lung cancer occurred between March 15, 2006 and June 30, 2009. Among all discharges, 9% received chemotherapy and 29% had surgery. The PCS was consulted for 8% of all lung cancer patients most commonly to address end-of-life-issues. PCS patients were more likely to be at the end-of-life than UC patients as evidenced by higher hospital mortality (31% versus 7%), higher intensive care (ICU) mortality (67% versus 16%) and more frequent discharge to hospice (41% versus 7%). PCS patients were hospitalized a median of 6 days before a referral was made. Hospitalization was significantly longer for PCS patients (M = 16.3 days, p < 0.001) than UC patients (M = 8.3 days).


CONCLUSIONS
In the first 3 years of a new palliative care initiative consults for lung cancer patients occurred late in the hospital stay or when death was imminent.
Reville
Barbara
B
Jefferson Palliative Care Service, Thomas Jefferson University, Department of Family & Community Medicine, Philadelphia, Pennsylvania 19107, USA. Barbara.Reville@jefferson.edu
Miller
Marshal N
MN
Toner
Richard W
RW
Reifsnyder
JoAnne
J
D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007297:Inpatients; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007902:Length of Stay / Q000706:statistics & numerical data; D008175:Lung Neoplasms / Q000401:mortality / Q000451:nursing* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013727:Terminal Care