Timely Reporting of Palliative Care Needs Leads to More Appropriate End-of-Life Care in NSCLC

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Researchers accessed the French National Hospital registry and obtained the records of 64,950 patients who died of metastatic NSCLC between 2010 and 2013.
Researchers accessed the French National Hospital registry and obtained the records of 64,950 patients who died of metastatic NSCLC between 2010 and 2013.

Timely reporting of palliative care needs is associated with less aggressive therapy and end-of-life care among patients with non-small cell lung cancer (NSCLC), according to a study published in Cancer.1

Previous studies have shown that the early incorporation of palliative care for patients with advanced, newly diagnosed NSCLC leads to improved quality of life and less aggressive care during the final weeks of life. The identification and appropriate timing of palliative care referral may lead to more appropriate management of this patient population. 

For this retrospective study, researchers accessed the French National Hospital registry and obtained the records of 64,950 patients who died of metastatic NSCLC between 2010 and 2013. Investigators analyzed the correlation between the various treatments and care methods used for these patients and the timing of the first referral of palliative care needs. Timing was categorized as timely (from 91 to 31 days before death), late (30 to 8 days before death), and very late (7 to 0 days before death).

Results showed that 26.3%, 31.5%, and 12.8% of reporting was timely, late, and very late, respectively, and 29.4% (19,106) of patients did not have their palliative care needs reported.

Patients who had timely palliative care need referrals had the earliest and the most progressive decrease in use of anticancer treatment. The probability of receiving chemotherapy decreased to 8.6% from 33.2% among patients whose needs were reported in a timely manner compared with 13.8% from 28.7% among patients who did not have any palliative care needs reported. Among patients who received chemotherapy during the second or third months before death, 37.5%, 49.4%, and 55.4% of patients whose needs were reported in a timely or late, very late, and no reporting, respectively, continued chemotherapy until death.

The use of invasive ventilation increased accordingly with delays in palliative care needs reporting; among patients who did not have their palliative care needs reported, the incidence of ventilation increased over the last 3 months of life from 0.7% to 7.5%.

The authors concluded that these findings “have the potential to improve current practice and help us to tailor adequate strategies to better integrate palliative care into mainstream oncology.”

Reference

  1. Goldwasser F, Vinant P, Aubry R, et al. Timing of palliative care needs reporting and aggressiveness of care near the end of life in metastatic lung cancer: a national registry-based study [published online May 9, 2018]. Cancer. doi: 10.1002/cncr.31536

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