Differences in Health Care and Palliative Care Use at the End of Life: A Comparison Study Among Lung Cancer, COPD, and Idiopathic Pulmonary Fibrosis

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Patients with lung cancer, idiopathic pulmonary fibrosis (IPF), and chronic obstructive pulmonary disease (COPD) have high symptom burden, poor quality of life, and high healthcare utilization at the end of life. While proactive integration of palliative care in lung cancer can improve outcomes, it is unclear whether similar practices have been adopted in COPD and IPF care. Do patients with COPD and IPF have different patterns of healthcare and palliative care use at the end of life compared to lung cancer? We retrospectively identified deceased patients with lung cancer, COPD, or IPF with ≥1 outpatient visit at [removed] in the last six months of life. We compared outpatient palliative care and opioid prescriptions, inpatient palliative care, hospitalizations, intensive care use, and in-hospital death in the last 6 months of life between each group. We used multivariable logistic regression to calculate adjusted odds ratios of each outcome, with lung cancer as the reference group. Among 1,819 patients, patients with COPD and IPF were more likely to be male and older at the time of death, compared to patients with lung cancer. Compared to lung cancer, patients with COPD and IPF had a lower adjusted odds (p<0.001) of receiving outpatient palliative care (aOR COPD: 0.26, 95% CI: 0.19-0.36; aOR IPF: 0.48, 95% CI: 0.32-0.70), outpatient opioids (aOR COPD: 0.50, 95% CI: 0.40-0.63; aOR IPF: 0.40, 95% CI: 0.29-0.54), and a higher odds of end-of-life ICU use (COPD aOR: 2.88, 95% CI: 2.11-3.93; IPF aOR: 4.15, 95% CI: 2.66-6.49). Patients with IPF had higher odds of receiving inpatient palliative care (aOR: 2.02, 95% CI: 1.30-3.13, p=0.002). Patients with COPD and IPF are less likely to receive outpatient palliative care and opioid prescriptions and more likely to use end-of-life intensive care than patients with lung cancer. Further research should explore health system barriers contributing to differences in care patterns to optimize quality of life and align with patient goals of care.