Chronic obstructive pulmonary disease and lung cancer: access to palliative care, emergency room visits and hospital deaths

Abstract

Background Despite the severe symptoms experienced by dying COPD patients, specialized palliative care (SPC) services focus mainly on cancer patients. We aimed to study the access to SPC that COPD and lung cancer (LC) patients receive and how that access affects the need for acute hospital care. Methods A descriptive regional registry study using data acquired through VAL, the Stockholm Regional Council’s central data warehouse, which covers nearly all healthcare use in the county of Stockholm. All the patients who died of COPD or LC from 2015 to 2019 were included. T-tests, chi-2 tests, and univariable and multivariable logistic regression analyses were performed on the accumulated data. Results In total, 6479 patients, (2917 with COPD and 3562 with LC) were studied. The patients with LC had more access to SPC during the last three months of life than did those with COPD (77% vs. 18%, respectively; p < .0001), whereas patients with COPD were more likely to be residents of nursing homes than those with LC (32% vs. 9%, respectively; p < .0001). Higher socioeconomic status (SES) (p < .01) and patient age < 80 years (p < .001) were associated with increased access to SPC for LC patients. Access to SPC correlated with fewer emergency room visits (p < .0001 for both COPD and LC patients) and fewer admissions to acute hospitals during the last month of life (p < .0001 for both groups). More COPD patients died in acute hospitals than lung cancer patients, (39% vs. 20%; χ2 = 287, p < .0001), with significantly lower figures for those who had access to SPC (p < .0001). Conclusions Compared to dying COPD patients, LC patients have more access to SPC. Access to SPC reduces the need for emergency room visits and admissions to acute hospitals.

Palliative oncology and palliative care

“…Access to palliative care also differs between countries. For example, in Sweden, sex is not a determinant of palliative care, whereas age seems to be an important factor insofar as younger patients have a greater access to SPC than do older patients [37], in line with other studies [62].…”

“…Moreover, SPC providers can provide adequate and timely care for cancer patients in the late stages of disease within the available services. In this way, the integration of SPC with cancer care translates into fewer emergency department visits, fewer readmissions to hospitals, and fewer cases where patients die following acute hospitalization [ 34 , 35 , 36 , 37 ].…”

“…This is not least because SPC services can successfully manage symptoms and acute conditions [ 14 ]. These successes translate into significantly fewer emergency room visits, fewer acute admissions to hospitals, and fewer hospital deaths [ 37 , 63 ]. Since many patients prefer home as their place of death, fewer hospital deaths are also a quality of life issue [ 64 ].…”

Acute healthcare utilization in end-of-life among Swedish brain tumor patients – a population based register study

“…Considering this, our finding that sex, when controlled for other variables, was not statistically associated and SES was only marginally associated with SPC is encouraging. The finding of an inverse association of age and SPC is in line with previous studies [ 36 , 37 ].…”

Benefits, for patients with late stage chronic obstructive pulmonary disease, of being cared for in specialized palliative care compared to hospital. A nationwide register study

“…Our study indicate that patients with COPD need support to manage severe symptoms including anxiety [ 46 ] and need both medical treatment and psychological support [ 26 ], which is provided in palliative care. Admissions to SPC should be considered more often, as recent Swedish data show that COPD patients admitted to SPC have a reduced need of emergency room visits and have more seldom hospital as their place of death [ 47 ]. A pre-emptive approach, instead of reacting when a high-intensity symptom already is present, is a main issue in palliative care, which is also applicable to hospital care of COPD patients.…”