title: Impact of early palliative interventions on the outcomes of care for patients with non-small cell lung cancer.
abstract: The aim of this study is to address the question "does early palliative care in addition to standard oncology care or late additional palliative care improve patterns of terminal care in patients who died from non-small cell lung cancer (NSCLC)?"
  
  
  
  We performed retrospective single-institution study of 286 patients. Palliative care was provided by a dedicated multidisciplinary palliative care team (PCT). An arbitrarily defined cutoff of 3 months before death was chosen to distinguish between early and late additional palliative care. Referral was at the discretion of the treating physicians who provided standard anticancer treatments.
  
  
  
  Patients who received early (8 %) or late (27 %) additional palliative care were significantly younger than those who did not receive additional palliative care. The likelihood of active anticancer treatment in the last month of life was lowest in the early additional palliative care group, p = 0.03. Patients who received early or late additional palliative care were significantly less likely to lack a documented resuscitation preference, p = 0.0001. Patients who received early additional palliative care were significantly less likely to become hospitalized in the last 3 months of life, p = 0.003. Place of death was also numerically different, with hospital death occurring in 33 % of patients who received early additional palliative care, as compared to 48 % in the late and 50 % in the no PCT group, p = 0.35. Anticancer treatment intensity was not reduced if the PCT contributed to the overall management.
  
  
  
  Early additional palliative care resulted in relevant improvements. The optimal timing of this intervention should be examined prospectively.
authors.affiliation: Departments of Oncology and Palliative Medicine, Nordland Hospital Trust, P.O. Box 1480, 8092, Bodø, Norway. carsten.nieder@nlsh.no.|Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway. carsten.nieder@nlsh.no.
authors.forename: Carsten
authors.initials: C
authors.lastname: Nieder
authors.affiliation: Departments of Pulmonology, Nordland Hospital Trust, Bodø, Norway.
authors.forename: Terje
authors.initials: T
authors.lastname: Tollåli
authors.affiliation: Departments of Oncology and Palliative Medicine, Nordland Hospital Trust, P.O. Box 1480, 8092, Bodø, Norway.|Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
authors.forename: Ellinor
authors.initials: E
authors.lastname: Haukland
authors.affiliation: Departments of Pulmonology, Nordland Hospital Trust, Bodø, Norway.
authors.forename: Anne
authors.initials: A
authors.lastname: Reigstad
authors.affiliation: Departments of Pulmonology, Nordland Hospital Trust, Bodø, Norway.
authors.forename: Liv Randi
authors.initials: LR
authors.lastname: Flatøy
authors.affiliation: Departments of Oncology and Palliative Medicine, Nordland Hospital Trust, P.O. Box 1480, 8092, Bodø, Norway.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Engljähringer
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology / Q000628:therapy*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000379:methods*; D012189:Retrospective Studies; D013727:Terminal Care; D016896:Treatment Outcome
keywords: Best supportive care; Chemotherapy; End-of-life care; Non-small cell lung cancer; Palliative care