Palliative procedures in patients with advanced lung cancer: Analysis from a prospective outcomes database

Abstract

8606 Background: Decisions regarding the appropriate use of palliative procedures continue to challenge those who care for patients with advanced cancer. This study examines the outcomes of palliative procedures performed for lung cancer compared to other primary malignancies. Methods: Procedures to explicitly palliate symptoms of advanced cancer were identified prospectively. Patients were observed for >90 days or until death. Clinical outcomes were evaluated based on the type of primary malignancy. Results: There were 1,022 palliative procedures performed in 823 patients from July 2002 to June 2003. Palliative procedures were most commonly performed in patients with lung cancer (14%, 117/823) for neurologic symtpoms-39%, shortness of breath-29%, gastrointestinal obstruction-15%, and other symtpoms-17%. Symptom improvement or resolution within 30 days was less common in patients with lung cancer (66%, 77/117) than in those with other primary malignancies (82%, 579/706, p=0.02). As observed in other cancers, recurrence of the primary symptom occurred in 25% (p=0.46) while treatment of debilitating additional symptoms was required in 30% (p=0.39). Palliative procedures in patients with lung cancer were associated with similar 30-day postoperative morbidity (33% versus 34%, p=0.97) but increased mortality (22% versus 10%, p<0.001). Median overall survival from the time of the palliative procedure was significantly shorter in patients with lung cancer than all other primary malignancies (90 days versus 124 days, p<0.001). Conclusions: Careful patient selection for palliative procedures is required in patients with advanced lung cancer. These interventions are associated with shorter anticipated survival, higher perioperative mortality and less frequent symptom resolution compared to palliative procedures performed in patients with other primary malignancies. Symptom severity may necessitate, however, palliative procedures in patients with lung cancer. The compelling nature of shortness of breath often dictates intervention regardless of durability and illustrates the importance of symptom relief for a significant percentage of remaining life even when measured in days. No significant financial relationships to disclose.