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

Peter Strang,Per Fürst,Jenny Bergqvist,Christel Hedman,Torbjörn Schultz,Helena Adlitzer

doi:10.1186/s12890-021-01533-3

Abstract

BackgroundDespite 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.MethodsA 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.ResultsIn 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).ConclusionsCompared 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.

Highlights

Despite the severe symptoms experienced by dying chronic obstructive pulmonary disease (COPD) patients, specialized palliative care (SPC) services focus mainly on cancer patients
The patients who died from COPD were older (80.2 years) than those with lung cancer (LC) (72.7 years) (p < 0.0001)
We found that access to palliative care was not related to sex, in contrast to a recent study on COPD and LC by Kendzerska et al, who observed that women received more palliative home care than men [19]

Summary

Introduction

Despite the severe symptoms experienced by dying COPD patients, specialized palliative care (SPC) services focus mainly on cancer patients. Mild forms of chronic obstructive pulmonary disease (COPD) may remain undiagnosed, severe forms cause distressing and complex symptoms, especially in the end-of-life (EOL) [1] While respiratory symptoms, such as cough, sputum production, and dyspnea can be disturbing for the patient early in the course of the. Efforts have been made to establish reliable prognostic factors, both in the form of single factors and as prognostic indices, with some consensus on group level; difficulties in establishing a prognosis for individual patients remain [4, 5] Respiratory factors, such as dyspnea, FEV1%, COPD exacerbations, exercise capacity, inspiratory fraction and inspiratory capacity are frequently suggested as predictors of death, along with comorbidities and older age [6]. To improve the predictive capacity of these variables, constructs have been used, such as BODE, comprising Body Mass Index, Obstruction, Dyspnea, and Exercise capacity [7], ADO (Age, Dyspnea, and Obstruction) [8, 9] and DOSE (Dyspnea, Obstruction, Smoking, and Exercise capacity) [10]

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Discussion

Conclusion