Indicators for early assessment of palliative care in lung cancer patients: a population study using linked health data

Abstract

BackgroundAnalysing linked, routinely collected data may be useful to identify characteristics of patients with suspected lung cancer who could benefit from early assessment for palliative care. The aim of this study was to compare characteristics of newly diagnosed lung cancer patients dying within 30 days of diagnosis (short term survivors) with those surviving more than 30 days. To identify indicators for early palliative care assessment we distinguished between characteristics available at diagnosis (age, gender, smoking status, marital status, comorbid disease, admission type, tumour stage and histology) from those available post diagnosis. A second aim was to examine the association between receiving any tumour-directed treatment, place of death and survival time.MethodsA retrospective observational population based study comparing lung cancer patients who died within 30 days of diagnosis (short term survivors) with those who survived longer using Chi-squared tests and logistic regression. Incident lung cancer (ICD-03:C34) patients diagnosed 2005–2012 inclusive who died before 01–01-2014 (n = 14,228) were identified from the National Cancer Registry of Ireland linked to death certificate data and acute hospital episode data.ResultsOne in five newly diagnosed lung cancer patients died within 30 days of diagnosis. After adjusting for stage and histology, death within 30 days was higher in patients who were aged 80 years or older (adjusted OR 2.46; 95%CI 2.05–3.96; p < 0.001), patients with emergency admissions at diagnosis (adjusted OR 2.96; 95%CI 2.61–3.37; p < 0.001) and patients with any comorbidities at diagnosis (adjusted OR 1.32 95%CI 1.15–1.52; p < 0.001). Overall, 75% of those who died within 30 days died in hospital compared to 43% of longer term survivors.ConclusionsWe have shown a high proportion of lung cancer patients who die within 30 days of diagnosis are older, have comorbidities and are admitted through the emergency department. These characteristics, available at diagnosis, may be useful prognostic factors to guide decisions on early assessment for palliative care for lung cancer patients. Patients who die shortly after diagnosis are more likely to die in hospital so reporting place of death by survival time may be useful to evaluate interventions to reduce deaths in acute hospitals.

Implementing ‘Goals of Care’ discussion and palliative care referral for patients with advanced lung cancer: an outpatient‐based pilot project

“…Factors associated with palliative care referral have been extensively examined in the literature 4,6,13–16,22,23 . Our cohort confirmed the association between age and poorer performance status and both palliative care referral and GOC completion.…”

“…Given the superior survival of patients with a targetable oncogenic driver compared to the remainder of the NSCLC population, 1,3 it is perhaps not surprising that these patients are less commonly referred to palliative care at diagnosis. Other factors known to be associated with palliative care referral, such as comorbidities and emergency department presentations or admissions 23 were not assessed in this small study.…”

The impact of initial treatment strategy and survival time on quality of end-of-life care among patients with oesophageal and gastric cancer: A population-based cohort study

“…This indicates that time since diagnosis is an important factor for quality of EOL care, in line with earlier research [45][46][47]. Kelly et al showed that patients with lung cancer who died within 30 days of diagnosis were more likely to die in hospital compared to long-term survivors [48], and Brooks el al. found a negative association between survival time and in-hospital death, with patients surviving <6 months having the greatest risk [46].…”

Using linked administrative health data for palliative and end of life care research in Ireland: potential and challenges

“…Key characteristics of the datasets are described in Table 2 . Based on our experience using cancer registry data linked to death certificate data and hospital episode data 36 , 37 we focus on these three datasets initially outlining their strengths and weaknesses for PEoLC research and then briefly describe the others.…”

“…Studies using cancer registry data linked to hospital episode data for PEoLC research have been published in Ireland. One study examined the palliative care needs of lung cancer patients 36 and a second evaluated the receipt of specialist palliative cancer care in acute hospitals 37 . A feature of these studies is careful study design driven by background knowledge of the data available.…”