Lung cancer and end-of-life care: a systematic review and thematic synthesis of aggressive inpatient care

Abstract

ObjectivesDespite recent advances in thoracic oncology, most patients with metastatic lung cancer die within months of diagnosis. Aggressiveness of their end-of-life (EOL) care has been the subject of numerous studies. This study was undertaken to evaluate the literature on aggressive inpatient EOL care for lung cancer and analyse the evolution of its aggressiveness over time.MethodsA systematic international literature search restricted to English-language publications used terms associated with aggressiveness of care, EOL and their synonyms. Two independent researchers screened for eligibility and extracted all data and another a random 10% sample of the abstracts. Electronic Medline and Embase databases were searched (2000–20 September 2018). EOL-care aggressiveness was defined as follows: 1) chemotherapy administered during the last 14 days of life (DOL) or new chemotherapy regimen during the last 30 DOL; 2) >2 emergency department visits; 3) >1 hospitalisation during the last 30 DOL; 4) ICU admission during the last 30 DOL and 5) palliative care started <3 days before death.ResultsAmong the 150 articles identified, 42 were retained for review: 1 clinical trial, 3 observational cohorts, 21 retrospective analyses and 17 administrative data-based studies. The percentage of patients subjected to aggressive therapy seems to have increased over time. Early management by palliative care teams seems to limit aggressive care.ConclusionsOur analysis indicated very frequent aggressive EOL care for patients with lung cancer, regardless of the definition used. The extent of that aggressiveness and its impact on healthcare costs warrant further studies.

The Role of Palliative Care in the Management of Patients with Lung Cancer

“…Aggressive end-of-life care Multiple recent studies have noted a trend in increasing use of aggressive inpatient end-of-life care, including intensive care unit stays and use of anticancer therapies near the end-of-life in lung cancer patients [33][34][35][36]. Aggressive cancer therapy in the last month of life is associated with increased likelihood of dying in the hospital.…”

Aggressiveness of Care at the End-of-Life in Cancer Patients and Its Association With Psychosocial Functioning in Bereaved Caregivers

“…While some patients benefit from innovative treatments for advanced cancer (1)(2)(3), an increasing number of patients are intensively and aggressively treated until the end of life (4)(5)(6)(7)(8)(9). The concept aggressiveness of care (AOC) summarizes this development and is defined by the following empirically identified factors: 1) start of a new chemotherapy regimen within the last month of life, 2) chemotherapeutic treatment within the last 14 days before death, 3) more than one emergency department visit within the last month of life, 4) more than 14 days hospitalization within the last month of life, 5) more than one hospital admission within the last month of life, and 6) admission to intensive care unit (ICU) within the last month of life (10).…”

Initial Experience after Transition to Immune Checkpoint Inhibitors in Patients with Non-small Cell Lung Cancer Treated in a Rural Healthcare Region

“…In Norway, the national lung cancer group (NLCG) and the governmental commission for approval and remuneration of new drugs have sequentially introduced monotherapy with pembrolizumab in first-line treatment for patients with high PD-L1 expression, monotherapy with atezolizumab in second-line for patients with PD-L1 positive tumors, and combined pembrolizumab/platinum/pemetrexed in first-line for patients with non-squamous NSCLC. Traditionally, overly aggressive end-of-life (EOL) care has been identified as one of several challenges in the treatment of incurable NSCLC [9]. Together with several other groups from various countries, we have previously examined the patterns of palliative care, terminal care, and hospital death in patients with NSCLC [10][11][12].…”