End of Life Care in Hospitalized Patients With Lung Cancer

Abstract

<h3>Purpose/Objective(s)</h3> Most patients with lung cancer lack access to palliative care support until later stages of their disease, resulting in needless aggressive care and healthcare resource utilization towards the end of life. We sought to study practices surrounding the delayed initiation of palliative care services in hospitalized patients with advanced lung cancer. <h3>Materials/Methods</h3> This retrospective cross-sectional analysis included hospitalized patients with advanced lung cancer that received palliative care consultation from July 2020- to March 2021 at our academic tertiary care medical center. Patients were categorized as ‘early consult' if palliative care was initiated within 5 days of admission. ANOVA and Chi-square tests were used for analysis and a p value of <0.05 was considered statistically significant. <h3>Results</h3> A total of 43 patients were included for analysis, out of which, a majority of the patients had Stage IV non-small cell lung cancer (22/43, 52.3%). None (0%) had received palliative care support prior to admission and only 4.8% had advance care planning documentation. The average delay in palliative care consult from the time of admission was 5.69±6.06 days. The length of stay following palliative care initiation and the total length of stay were 4.28±4.18 days and 10.35±6.31 days respectively. Patients with a total hospital stay >10 days were significantly older than patients with a length of stay <10 days (60.7±7.4 days vs 65.6±5.7 days, p=0.02). During their hospitalization, 66.6% (28/43) of the patients received invasive procedures; which did not change with early vs late initiation of palliative care during hospitalization (p=0.65). Majority of the patients were discharged to hospice (21/43, 48.8%), which was not facilitated by earlier inpatient palliative care consultation (p=0.11). <h3>Conclusion</h3> The current study shows that a vast majority of patients with advanced lung cancer lack access to adequate palliative care support and continue to receive aggressive care including prolonged hospitalization and invasive procedures towards the end of life. There is a need to introduce palliative care services earlier, on an outpatient basis to improve advance care planning discussions and prevent gratuitous procedures and aggressive care towards the end of life.