A population-based study of the pattern of terminal care and hospital death in patients with non-small cell lung cancer.
Non-small cell lung cancer (NSCLC) is a major cause of cancer-related death and utilization of health care resources worldwide. Significant costs are generated in the months before death, with hospitalization being a major cost driver. Moreover, hospital death causes physical and emotional distress. We analyzed factors predicting the likelihood of hospital death from NSCLC. Patients who died from NSCLC (any stage and treatment) during the recent 5-year interval up to 31.12.2010, within a defined geographical region of northern Norway, were included (n=112). Only 15% of all patients did not require any hospitalization during their last 3 months. A minority of patients (24%) died at home, 53% in hospital and 23% in nursing homes. The likelihood of hospital death was independent of initial management and time between diagnosis and death. Even 45% of patients treated with best supportive care died in hospital. Multivariate analysis showed that initial tumor stage of T4 (RR 1.64), systemic therapy during the last 3 months of life (RR 2.60) and any active therapy during the last 4 weeks (RR 1.63) significantly increased the likelihood of hospital death, while early discussion of resuscitation preferences reduced it (RR 0.21). These four parameters suggest that early focus on symptom palliation and resuscitation preferences are crucial components of strategies improving terminal care. Patients with T4 tumors might experience unsatisfactory symptom control and should be offered a part in prospective studies addressing these issues.
Department of Oncology and Palliative Medicine, Nordland Hospital, P.O. Box 1480, 8092 Bodø, Norway. carsten.nieder@nlsh.no
Carsten
C
Nieder
Terje
T
Tollåli
Jan
J
Norum
Adam
A
Pawinski
Roy M
RM
Bremnes
D000230:Adenocarcinoma / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D000368:Aged; D000369:Aged, 80 and over; D018287:Carcinoma, Large Cell / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D002289:Carcinoma, Non-Small-Cell Lung / Q000453:epidemiology* / Q000401:mortality* / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008175:Lung Neoplasms / Q000453:epidemiology / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009664:Norway / Q000453:epidemiology; D010166:Palliative Care / Q000639:trends; D012189:Retrospective Studies; D015996:Survival Rate; D013727:Terminal Care / Q000639:trends*; D016896:Treatment Outcome