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Aggressiveness of care in a prospective cohort of patients with advanced NSCLC†
Article first published online: 10 JUL 2008
Copyright © 2008 American Cancer Society
Volume 113, Issue 4, pages 826–833, 15 August 2008
How to Cite
Temel, J. S., McCannon, J., Greer, J. A., Jackson, V. A., Ostler, P., Pirl, W. F., Lynch, T. J. and Billings, J. A. (2008), Aggressiveness of care in a prospective cohort of patients with advanced NSCLC. Cancer, 113: 826–833. doi: 10.1002/cncr.23620
Portions of this study were presented in poster format at the ASCO Annual Meeting, Chicago, Illinois, June 2007.
- Issue published online: 1 AUG 2008
- Article first published online: 10 JUL 2008
- Manuscript Accepted: 18 MAR 2008
- Manuscript Revised: 14 MAR 2008
- Manuscript Received: 23 OCT 2007
- NCI-sponsored. Grant Number: R03CA128478
- end-of-life care;
- nonsmall-cell lung cancer;
- hospice care;
Optimal end of life care of patients with terminal cancer is poorly understood. In this study, the aggressiveness of care is described in a cohort of patients with newly diagnosed advanced nonsmall-cell lung cancer (NSCLC).
Patients within 8 weeks of diagnosis of stage IIIb (with effusions) or IV NSCLC were enrolled in a study to examine the feasibility of involving palliative care services early in the provision of cancer care. Participants received standard oncology treatment and integrated palliative care. All patients were followed prospectively to assess anticancer therapy usage, hospital admissions, hospice utilization, and location of death.
At the time of analysis, 40/46 (87%) of enrolled patients had died, with a median length of follow-up of 29.3 months. Aggressive care measures in the final month of life included rates of anticancer therapy (40%), emergency department visits (48%), and hospital admissions (50%). Sixty-five percent of patients received hospice care before death, with a median length of stay of 16 days. Patients with heightened baseline anxiety and mood symptoms were more likely to receive anticancer therapy at the end of life compared with those without such symptoms.
This study demonstrates the frequent use of aggressive measures at the end of life among patients with advanced NSCLC in a tertiary care center, as shown by the number of patients receiving anticancer therapy within 30 days of death and brief utilization of hospice services. Further research is needed to identify predictors of aggressive care and to develop interventions enhancing decision-making at the end of life. Cancer 2008. © 2008 American Cancer Society.