title: Implementation status and explanatory analysis of early advance care planning for Stage IV non-small cell lung cancer patients.
abstract: OBJECTIVE
  The American Society of Clinical Oncology published the goals of individualized care including advance care planning for advanced cancer patients in 2011. However, no data are available on the implementation status of advance care planning.
  
  
  METHODS
  We retrospectively reviewed the electronic medical records and informed consent forms of consecutive Stage IV non-small cell lung cancer patients treated with chemotherapy between January 2010 and December 2012 at our institution. Two outcomes were defined to investigate the advance care planning implementation status: C-D, the duration from the last day of chemotherapy to death and D-D, that from the day of confirmed do-not-attempt-resuscitation order to death.
  
  
  RESULTS
  The study included 136 eligible patients. The advance care planning implementation status in participating patients was as follows: 96 (70%) patients received information on 'incurable disease before first-line chemotherapy', 69 (50%) were informed about 'supportive care before first-line chemotherapy', whereas 43 (32%) learned about their prognosis. The do-not-attempt-resuscitation decision was reflected in 29 patients' will (21%). The median C-D was 64 days. Receipt of ≤2 chemotherapy regimens and provision of prognosis information to patients were significantly associated with long C-D in multivariate analysis. The median D-D was 25 days. Provision of information on supportive care before first-line chemotherapy and provision of prognosis information to patients were significantly associated with long D-D in multivariate analysis.
  
  
  CONCLUSIONS
  Our results suggest that there is possible benefit from providing information on supportive care before first-line chemotherapy and informing patients about their prognosis in prolonging the duration of supportive care.
authors.affiliation: Division of Palliative Medicine, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun Division of Respirology, Neurology and Rheumatology, Department of Internal Medicine, Kurume University School of Medicine, Fukuoka tokitou_takaaki@kurume-u.ac.jp.
authors.forename: Takaaki
authors.initials: T
authors.lastname: Tokito
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun.
authors.forename: Haruyasu
authors.initials: H
authors.lastname: Murakami
authors.affiliation: Clinical Trial Coordination Office, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Mori
authors.affiliation: Division of Palliative Medicine, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun.
authors.forename: Iwao
authors.initials: I
authors.lastname: Osaka
authors.affiliation: Division of Thoracic Oncology, Shizuoka Cancer Center, Nagaizumi-cho Sunto-gun.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Takahashi
mesh_terms: D000328:Adult; D032722:Advance Care Planning; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D059248:Chemoradiotherapy / Q000379:methods; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods; D011379:Prognosis; D016414:Resuscitation Orders; D012189:Retrospective Studies
keywords: advance care planning; do-not-attempt-resuscitation; lung cancer; prognosis; supportive care