Mortality and symptom burden from chronic obstructive pulmonary disease (COPD) and lung cancer are similar but there is thought to be an inequality in palliative care support (PCS) between diseases. This nationally representative study assessed PCS for COPD patients within primary care in the UK.This was a cohort study using electronic healthcare records (2004–2015). Factors associated with receiving PCS were assessed using logistic regression for the whole cohort and deceased patients.There were 92 365 eligible COPD patients, of which 26 135 died. Only 7.8% of the whole cohort and 21.4% of deceased patients received PCS. Lung cancer had a strong association with PCS compared with other patient characteristics, including Global Initiative for Chronic Obstructive Lung Disease stage and Medical Research Council Dyspnoea score (whole cohort, lung cancer: OR 14.1, 95% CI 13.1–15; deceased patients, lung cancer: OR 6.5, 95% CI 6–7). Only 16.7% of deceased COPD patients without lung cancer received PCS compared with 56.5% of deceased patients with lung cancer. In patients that received PCS, lung cancer co-diagnosis significantly increased the chances of receiving PCS before the last month of life (1–6 versus ≤1 month pre-death: risk ratio 1.4, 95% CI 1.3–1.7).Provision of PCS for COPD patients in the UK is inadequate. Lung cancer, not COPD, was the dominant driver for COPD patients to receive PCS.

Introduction and ObjectiveOver 5% of UK deaths are secondary to COPD, only 1% less than from lung cancer. Yet, there remains a lack of palliative care support (PCS) for COPD patients, despite evidence that it improves their quality of life, improving both physical and physiological symptoms. NICE guidelines recommend its provision to all patients with end-stage COPD. Previous studies have found poor access for COPD patients in secondary care, this study aimed to assess PCS within primary care.MethodsPopulation-based open cohort study, January 2004 to June 2015, using electronic healthcare records (Clinical Practice Research Datalink). Associations with PCS were measured using logistic regression.Results92,365 COPD patients were included (median follow-up=4.2 years). Only 7.5% received PCS; of whom 47% had lung cancer. Only 21% of all deceased COPD patients received PCS, and within 6 months from their death only 48% of those patients had received PCS, by 3 months before their death up to 69% had received PCS (figure 1). Around a third of these patients had co-existing lung cancer (figure 1). The adjusted odds of receiving PCS was 14.6 times higher for COPD patients with lung cancer than without (95% CI 13.2–16.1), and 6.3 times higher for deceased COPD patients with lung cancer than without (95% CI 5.6–7.1), adjusted for gender, age, BMI, MI, heart failure, stroke, smoking, GOLD stage, MRC Dyspnoea grade, exacerbations, anxiety and depression. The proportion of patients that received PCS yearly increased gradually from 2004 to 2014, but remained low, only 2.1% of patients in the cohort in 2014 received PCS in 2014.ConclusionsThere was limited PCS for COPD patients; this appeared to be strongly driven by a co-existing diagnosis of lung cancer, not by their advanced COPD disease. PCS was often provided only towards the end of patient’s lives; this may have been related to the difficulty in prognosticating the end-of-life for individuals with COPD. Encouragingly PCS increased yearly and could indicate recognition of its value and thus the requisite to discuss PCS with patients, however, this clearly remains an important unmet need.Abstract S126 Figure 1Graph of the 21% of deceased COPD patients that received PCS: showing how soon before their death they were provided with PCS.

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