Abstract

BackgroundWe aimed to study the mortality and intensity of health care in patients with advanced lung cancer who received systemic anti-cancer treatment (SACT) compared with patients who were not eligible for SACT (no-SACT).MethodsA retrospective cohort of patients with lung cancer, who were treated at the North Estonia Medical Centre from 2015 to 2017, was linked to population-based health care data from the Estonian Health Insurance Fund. We calculated 14- and 30-day mortality after SACT and used a composite measure of intensity of care, comprised from the following: emergency department visit, admission to hospital, admission to intensive care unit, receipt of radiotherapy or systemic treatment.ResultsThe median overall survival (OS) of patients who received at least one cycle of SACT (n = 489) was 9.1 months and in patients with no-SACT (n = 289) 1.3 months (hazard ratio [HR] = 4.23, 95% CI = 3.60–5.00). During the final 30 days of life, intensive EOL care was received by 69.9% of the SACT patients and 43.7% of the no-SACT patients. Intensive EOL care in the last 30 days of life is more probable among patients in the SACT group (odds ratio [OR] = 3.58, 95% CI = 2.54–5.04, p < 0.001), especially in those with a stage IV disease (OR = 1.89, 95% CI = 1.31–2.71, p = 0.001). In the SACT group 6.7 and 14.7% of patients died within 14 days and 30 days after the last cycle, respectively.ConclusionsSignificant proportion of patients with advanced lung cancer continue to receive intensive care near death. Our results reflect current patterns of EOL care for patients with lung cancer in Estonia. Availability of palliative care and hospice services must be increased to improve resource use and patient-oriented care.

Highlights

  • We aimed to study the mortality and intensity of health care in patients with advanced lung cancer who received systemic anti-cancer treatment (SACT) compared with patients who were not eligible for SACT

  • Characteristics of the study population and treatment patterns A retrospective cohort of patients with lung cancer, who were treated at the North Estonia Medical Centre during the study period from 2015 to 2017, was assembled using the institutional Thoracic Oncology Database (Fig. 1)

  • Intensive end of life (EOL) care in the last 30 days of life is more probable among patients in the SACT group, especially in those with a stage IV disease (OR = 1.89, 95% CI = 1.31–2.71, p = 0.001)

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Summary

Introduction

We aimed to study the mortality and intensity of health care in patients with advanced lung cancer who received systemic anti-cancer treatment (SACT) compared with patients who were not eligible for SACT (no-SACT). The internationally recognised intensity of care and quality of EOL care indicators in oncology are: intensive use of systemic anti-cancer treatment (SACT), low rates of hospice use, ED visits, hospitalisations and admissions to ICU; all measures occurring within 14 or 30 days of death [6,7,8]. These service-based indicators could be applied to existing administrative data to assess the utilisation of health care services at the EOL retrospectively. Previous studies assessing chemotherapy use at the EOL, have not always been able to discriminate between treatmentrelated and cancer-related mortality

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