Health-Related Quality of Life in End-Stage COPD and Lung Cancer Patients

Abstract

Historically, palliative care has been developed for cancer patients and is not yet generally available for patients suffering from chronic life-limiting illnesses, such as chronic obstructive pulmonary disease (COPD). To examine whether COPD patients experience similar or worse disease burden in comparison with non-small cell lung cancer (NSCLC) patients, we compared the health-related quality of life (HRQOL) scores of severe COPD patients with those of advanced NSCLC patients. We also formally updated previous evidence in this area provided by a landmark study published by Gore et al. in 2000. In updating this previous evidence, we addressed the methodological limitations of this study and a number of confounding variables. Eighty-two GOLD IV COPD patients and 19 Stage IIIb or IV NSCLC patients completed generic and disease-specific HRQOL questionnaires. We used an individual patient data meta-analysis to integrate the new and existing evidence (total n=201). Finally, to enhance between-group comparability, we performed a sensitivity analysis using a subgroup of patients with a similar degree of "terminality," namely those who had died within one year after study entry. Considerable differences in HRQOL were found for physical functioning, social functioning, mental health, general health perceptions, dyspnea, activities of daily living, and depression. All differences favored the NSCLC patients. The sensitivity analysis, using only terminal NSCLC and COPD patients, confirmed these findings. In conclusion, end-stage COPD patients experience poor HRQOL comparable to or worse than that of advanced NSCLC patients. We discuss these findings in the light of the notion that these COPD patients may have a similar need for palliative care.

Health-related quality of life and functional status in end-stage COPD: a longitudinal study

“…Patients were identified from the medical records of the outpatient clinics of four participating hospitals and one centre specialising in asthma and COPD, all situated in The Netherlands. Because data at baseline were compared to advanced lung cancer patients (described in detail elsewhere [21]), coexistence of stage IIIb or IV lung cancer was an exclusion criterion. Patients were asked to complete a selfadministered questionnaire at baseline and every 3 months over a period of 1 yr, with a maximum of four measurements per patient, including the baseline measurement.…”

“…It is also known that, despite these uncontrolled symptoms, patients in the end stage of COPD have limited access to specific palliative care services when compared to, for example, patients suffering from advanced lung cancer [11,19,20]. Crosssectional studies have shown that health-related quality of life (HRQoL) is low in these patients, even compared to advanced lung cancer patients [11,19,21]. CLAESSENS et al [20] state, in their report on the results of the Study to Understand Prognosis and Preferences for Outcomes and Risks of Treatments (SUPPORT), that despite similar preferences about end-of-life care, hospitalised patients with COPD were more likely to have mechanical ventilation, tube feeding and cardiopulmonary resuscitation, compared with patients with lung cancer.…”

The silence of patients with end-stage COPD: a qualitative study

“…12 In that study, 82 patients with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage IV (defined as forced expiratory volume in 1 second <30% of predicted) COPD who were aged 60 years or older were recruited randomly from outpatient clinics of four participating hospitals and one centre specialising in asthma and COPD in the Netherlands. Patients received a quality-of-life questionnaire every 3 months, for a maximum period of 1 year in total.…”

Life-Sustaining Procedures, Palliative Care, and Cost Trends in Dying COPD Patients in U.S. Hospitals: 2005~2014

“…https://doi.org/10.14475/kjhpc.2018.21.1.23 comparable or higher symptom burdens (i.e., shortness of breath, fatigue, pain, depression, and anxiety) (6,9-11) and poor QOL (11,12) compared to patients with any other advanced chronic illness.…”