title: Metastatic non-small cell lung cancer: a benchmark for quality end-of-life cancer care?
abstract: OBJECTIVE
  To investigate the quality of end-of-life care for patients with metastatic non-small cell lung cancer (NSCLC).
  
  
  METHODS
  Retrospective cohort study of patients from first hospitalisation for metastatic disease until death, using hospital, emergency department and death registration data from Victoria, Australia, between 1 July 2003 and 30 June 2010.
  
  
  METHODS
  Emergency department and hospital use; aggressiveness of care including intensive care and chemotherapy in last 30 days; palliative and supportive care provision; and place of death.
  
  
  RESULTS
  Metastatic NSCLC patients underwent limited aggressive treatment such as intensive care (5%) and chemotherapy (< 1%) at the end of life; however, high numbers died in acute hospitals (42%) and 61% had a length of stay of greater than 14 days in the last month of life. Although 62% were referred to palliative care services, this occurred late in the illness. In a logistic regression model adjusted for year of metastasis, age, sex, metastatic site and survival, the odds ratio (OR) of dying in an acute hospital bed compared with death at home or in a hospice unit decreased with receipt of palliative care (OR, 0.25; 95% CI, 0.21-0.30) and multimodality supportive care (OR, 0.65; 95% CI, 0.56-0.75).
  
  
  CONCLUSIONS
  Because early palliative care for patients with metastatic NSCLC is recommended, we propose that this group be considered a benchmark of quality end-of-life care. Future work is required to determine appropriate quality-of-care targets in this and other cancer patient cohorts, with particular focus on the timeliness of palliative care engagement.
authors: St Vincent's Hospital, Melbourne, VIC, Australia. jennifer.philip@svhm.org.au.
authors: Jennifer
authors: J
authors: Philip
authors: St Vincent's Hospital, Melbourne, VIC, Australia.
authors: Peter
authors: P
authors: Hudson
authors: St Vincent's Hospital, Melbourne, VIC, Australia.
authors: Adam
authors: A
authors: Bostanci
authors: La Trobe University, Melbourne, VIC, Australia.
authors: Annette
authors: A
authors: Street
authors: La Trobe University, Melbourne, VIC, Australia.
authors: Dell E
authors: DE
authors: Horey
authors: Cancer Institute NSW, Sydney, NSW, Australia.
authors: Sanchia
authors: S
authors: Aranda
authors: St Vincent's Hospital, Melbourne, VIC, Australia.
authors: Rachel
authors: R
authors: Zordan
authors: La Trobe University, Melbourne, VIC, Australia.
authors: Bruce D
authors: BD
authors: Rumbold
authors: St Vincent's Hospital, Melbourne, VIC, Australia.
authors: Gaye
authors: G
authors: Moore
authors: St Vincent's Hospital, Melbourne, VIC, Australia.
authors: Vijaya
authors: V
authors: Sundararajan
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000556:secondary; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy / Q000556:secondary* / Q000628:therapy; D015331:Cohort Studies; D003422:Critical Care; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D017051:Hospice Care / Q000592:standards; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008175:Lung Neoplasms / Q000188:drug therapy / Q000628:therapy*; D008207:Lymphatic Metastasis / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000592:standards*; D010351:Patient Discharge; D011787:Quality of Health Care; D012189:Retrospective Studies; D015996:Survival Rate; D013727:Terminal Care / Q000592:standards*; D014739:Victoria
chemical_list: D000970:Antineoplastic Agents