Terminal Lung Cancer Research Articles

Living for the Moment - How Important Is It in the End of Life?

This essay investigates the role of present-moment living in end-of-life care, drawing on reflections from a personal patient encounter in a palliative care setting, Mrs. B, a 63-year-old patient with terminal squamous cell lung cancer, whose experience underscores the impact of living with a sense of fulfillment and joy despite a life-limiting diagnosis. Mrs. B's approach to her illness-marked by an optimistic acceptance of mortality and a focus on daily joys-challenges traditional palliative care paradigms that emphasize somberness and future-oriented care. Through detailed narrative and reflective analysis, the essay highlights how Mrs. B's resilience and spiritual beliefs contributed to her ability to maintain a positive outlook in the face of terminal illness. This case study illustrates the potential for joy and present-moment living to coexist with palliative care practices, offering a nuanced perspective on patient care. The discussion extends to the implications for healthcare professionals, advocating for a more adaptable and empathetic approach that aligns with individual patient values and preferences. This reflection calls for a shift in palliative care practices towards recognizing and supporting the diverse ways patients navigate their end-of-life experiences.

Trends in pain undertreatment among lung cancer patients at the EOL: Analysis of urban city medical insurance data in China.

Cancer-related pain is one of the common priority symptoms in advanced lung cancer patients at the end-of-life (EOL). Alleviating pain is undoubtedly a critical component of palliative care in lung cancer. Our study was initiated to examined trends in opioid prescription-level outcomes as potential indicators of undertreated pain in China. This study used data on 1330 patients diagnosed with lung cancer of urban city medical insurance in China who died between 2014 and 2017. Opioid prescription-level outcomes were determined by annual trends of the proportion of patients filling an opioid prescription, the total dose of opioids filled by decedents, and morphine milligram equivalents per day (MMED) at the EOL (defined as the 60 days before death). We further analyzed monthly changes in the number of opioid prescriptions filled, MMED, and mean daily dose of opioids per prescription (MDDP) of the last 60 days of life by year at death and age, respectively. A total of 959 patients with exact dates of death were included, with 432 cases (45.06%; 95% CI: 44.36%-45.77%) receiving at least one opioid prescription at the EOL. The declining trends were shown in the proportion of patients filling any opioid prescription, the total dose of opioids filled by decedents and MMED, with an annual decrease of 0.341% (p = 0.01), 104.23 mg (p = 0.011) and 2.84 mg (p = 0.014), respectively. Within the 31-60 days to the 0-30 days of life, the MMED declined 6.08 mg (95% CI: -7.14 to -5.03; p = 0.000351), while the number of opioid prescriptions rose 0.66 (95% CI: 0.160-1.16; p = 0.025). Like the MMED, the MDDP fell 4.11 mg (95% CI: -5.86 to -2.37; p = 0.005) within the last month before death compared to the previous month. Terminal lung cancer populations in urban China have experienced reduced access to opioids at the EOL. The clinicians did not prescribe a satisfactory dose of opioids per prescription, while the patients suffered increasing pain in the last 30 days of life. Sufficient opioid analgesic administration should be advocated for lung cancer patients during the EOL period.

Life Review the Impact of Combined Watson Care Theory Intervention on Psychological Status and Quality of Life in Patients with Terminal Lung Cancer

Life Review the Impact of Combined Watson Care Theory Intervention on Psychological Status and Quality of Life in Patients with Terminal Lung Cancer

Effect of fat emulsion administration on blood coagulation in terminal lung cancer patients.

Patients with cancer, especially those with lung cancer, are at high risk of developing thrombosis. Intralipos® infusion 20% is contraindicated for thrombosis, and there is no consensus on whether it can be safely used in cases of advanced cancer. We conducted a retrospective observational study to elucidate the impact of fat emulsion administration on blood coagulation in patients with terminal lung cancer. The subjects were patients with terminal lung cancer in the Department of Surgery and Palliative Medicine, Fujita Health University Nanakuri Memorial Hospital between January 2016 and December 2019. We compared changes in their blood coagulation profile before hospitalization and one month later. There were a total of 213 patients with lung cancer-139 who were administered fat emulsion and 74 who were not-with no significant differences in baseline characteristics. In the fat emulsion administration group (n=27), the prothrombin time-international normalized ratio (PT-INR) and activated partial thromboplastin time (APTT), respectively, were 1.17±0.26 (mean±standard deviation) and 30.5±5.0s at hospitalization and 1.16±0.12 and 31.2±4.2s one month later with no significant differences. In the non-administration group (n=6), the PT-INR and APTT, respectively, were 1.44±0.43 and 30.6±5.2s before hospitalization and 1.28±0.18 and 33.0±7.5s one month later with no significant differences. We did not identify any changes in PT-INR and APTT after fat emulsion administration in patients with terminal lung cancer. There were also no new cases of thrombosis, suggesting that fat emulsions were administered safely in patients with terminal lung cancer.

Days at home in the last three months of life: patterns-of-care analysis in patients with non-small cell lung cancer.

To calculate the number of days patients with terminal non-small cell lung cancer (NSCLC) spent at home in the last 3 months of life, and to identify factors that predict a lower proportion of days at home. Retrospective study of 434 deceased patients with NSCLC. The number of days spent in a hospital or nursing home was identified from electronic health records. Most patients received primary chemotherapy. Only 45% received palliative care provided by a dedicated palliative care team (PCT). In the last 3 months of life, only 39 patients (9%) were not hospitalized. The median number of days spent in hospital was 17, range 0-61. Hospital death occurred in 48%. Admission to a nursing home was recorded in 45%. Overall, the patients spent a median of 64 days at home. Both, older patients and females spent fewer days at home. Family network and aspects of palliative care, possibly reflecting the symptom duration or burden, also impacted days at home. Long-lasting need for PCT support (not just the final 3 months) and earlier necessity for opioid analgesics were predictive for a reduced number of days at home. However, modifiable factors such as sex were identified too.

Influence of Preservatives on Insulin in Postmortem Blood: Application to a Case of Insulin Aspart Suicide.

Insulin aspart (NovoRapid®, NovoMix®, Novolog® and Fiasp®) is a fast-acting analog of human insulin, indicated in the treatment of type I and II diabetes. It is administered before meals to mimic the physiological insulin secretion that follows a rise in blood glucose. Its misuse for the purposes of suicide and murder and in the context of factitious order has often been described. In forensic medicine, the identification of insulin in biological samples has always been complex. In this paper, we present a case of suicide of a 64-year-old man who died after the injection of insulin aspart. He was suffering from terminal lung cancer and left a letter explaining the reasons for his suicide. Four empty NovoRapid® pens were found near the body. Body examination was unremarkable, and the femoral blood was collected in two dry Vacutainer™ tubes (red cap) and two sodium fluoride (NaF) tubes (gray cap). A liquid chromatography coupled to high-resolution mass spectrometry method was used to identify and discriminate insulin aspart from human insulin after immunopurification in the blood samples and in the pens. Blood specimens tested positive for insulin aspart with the concentrations of 36 and 37 ng/mL in dry tubes and 58 and 71 ng/mL in tubes containing NaF when tested ∼3 weeks after the collection of the specimens. The contents of the pens also matched with insulin aspart. The stability of insulin in blood is a critical point in the interpretation of the concentrations due to their rapid decrease caused by the activity of proteases in blood. During a degradation study implemented to compare three preservatives and dry tubes, suitable insulin aspart stability was observed with disodium salt of ethylenediaminetetracetic acid and NaF. Given that NaF is standard in forensic toxicology for measuring blood alcohol concentrations, the authors suggest its use for blood collection when insulin intoxication is suspected.

Is Hospital Hospice Service Associated with Efficient Healthcare Utilization in Deceased Lung Cancer Patients? Hospital Charges at Their End of Life.

In July 2015, South Korea began applying National Health Insurance reimbursement to inpatient hospice service. It is now appropriate and relevant to evaluate how hospice care is associated with healthcare utilization in terminal lung cancer patients. We used nationwide NHI claims data of lung cancer patients from 2008-2018 and identified a sample of patients deceased after July 2016. We transposed the dataset into a retrospective cohort design where a unit of analysis was each lung cancer patients' healthcare utilization. The differences in hospital charges per day were investigated depending on the patient's use of hospice service before death with the Generalized Linear Model (GLM) analysis. Additionally, subgroup analysis and the propensity score matching method were used to validate the model using the claims information of 25,099 patients. About 17.0% of patients used hospice services (N = 4260). With other variables adjusted, hospice service utilization by deceased lung cancer patients was associated with statistically significant lower hospital charges per day at the end of life (1 month, 3 months, and 6 months before death) compared to non-users. A similar trend was found in the propensity score matching model analysis. We found lower end-of-life hospital charges per day among lung cancer patients who received hospice services near death. The ever-expanding aging population requires health policymakers and the National Health Insurance program to expand hospice services for terminal cancer patients in underserved regions and hospitals that do not provide hospice.

Sarcopenia is an independent risk factor for depression in patients with advanced lung cancer.

Depression is the most prevalent psychological issue among cancer patients and can seriously affect patients' life and disease prognosis and even lead to suicide. Sarcopenia is a manifestation of cancer cachexia, a chronic progressive process. It is accompanied by a sustained decrease in skeletal muscle mass, muscle strength, and physical function and likewise has various negative effects on the patient. This study aimed to evaluate sarcopenia and other factors that may affect depression in patients with lung cancer and to further analyze and discuss. A total of 104 eligible patients were enrolled in this cross-sectional study, using the Hamilton Depression Scale to assess depression, obtaining the psoas muscle index (PMI) by computed tomography (CT), and performing the diagnosis of sarcopenia. Clinical and personal characteristics were collected by electronic medical records. We evaluated a total of 104 hospitalized cancer patients in this analysis, with mean age = 57.8 ± 11.0years, and 65.38% (68) were female. We found that up to 31.7% (33) of the participants had depression and 61.5% (64) of the participants had sarcopenia, and no statistical differences were found among depressed and non-depressed patients in relation to age, smoking, gender, performance status, and pathology. Patients with sarcopenia have more than four times the risk of suffering from depression than patients without sarcopenia (OR = 4.133, 95%CI = 1.390-12.287; p = 0.011). Similarly, the possibility of depression in patients with PD (progressive disease) as efficacy evaluation increased by 13.482 times (95%CI = 2.121-85.679, p = 0.006). In individuals with terminal lung cancer, depression and sarcopenia are prevalent. A strong association between the two is now thought to exist. Sarcopenia and efficacy evaluation are independent risk factors for depression. The correlation between sarcopenia and depression underscores the need for early intervention by our clinicians.

Erythematous Plaque on the Groin and Buttocks.

A 68-year-old man presented with an extensive erythematous plaque of 3 weeks’ duration that started in the groin and spread to the buttocks. He was admitted to the palliative care unit 1 year prior for the management of terminal lung cancer.

Proxy responses regarding quality of life of patients with terminal lung cancer: preliminary results from a prospective observational study

ObjectiveThis prospective study used the EQ-5D utility and Visual Analogue Scale (VAS) scores to analyse the potential usefulness of proxy responses in quality of life assessments of Japanese patients with...

Impact of interstitial pneumonia complications on palliative medication for terminal lung cancer: A single-center retrospective study.

Interstitial pneumonia (IP) is associated with high comorbidity of lung cancer (LC). We aimed to investigate whether concomitant IP affects palliative pharmacotherapy for end-stage symptom relief in patients with LC. We retrospectively examined the clinical records of LC patients who died in our hospital between 2015 and 2017. The patients were divided into the IP-LC (LC with comorbid IP) and LC (LC without IP) groups according to the presence of IP to compare the use of opioid and midazolam in their terminal period. In total, 236 patients were enrolled in this study and divided into the IP-LC (n=70) and LC (n=166) groups. Among them, 51.2% and 65.7% patients in the LC and IP-LC groups, respectively, required continuous opioid administration to relieve dyspnea and/or pain. There were no significant between-group differences in the median initial and maximum doses and continuous opioid administration duration. The frequency of concomitant use of continuous midazolam and opioids was higher in the IP-LC group than in the LC group (20.5% vs. 7.1%; p=0.01), primarily because of refractory dyspnea in all patients in both groups. The median survival time after the initiation of continuous opioid administration did not change irrespective of continuous midazolam administration. Compared with patients with LC, those with IP-LC are more likely to require continuous midazolam administration because continuously administered opioids alone are not sufficiently effective in relieving end-stage dyspnea among the latter.

Patients with Terminal Interstitial Pneumonia Require Comparable or More Palliative Pharmacotherapy for Refractory Dyspnea than Patients with Terminal Lung Cancer.

Background: Dyspnea is a severe symptom of terminal-stage interstitial pneumonia (IP). We commonly use continuous morphine or midazolam for terminal refractory dyspnea.Objective: We aimed to determine whether there is a difference in the use of continuous morphine and midazolam for terminal dyspnea between IP patients and lung cancer (LC) patients.Design: This is a single-center retrospective study.Setting/Subjects/Measurements: We retrospectively examined the clinical records of IP and LC patients who had died in our hospital. These patients were divided into the IP and LC groups to compare the use of morphine and midazolam.Results: Continuous morphine was administered to 50.0% of those in the IP group and 38.0% of those in the LC group for terminal dyspnea. There was no difference in the effect at six hours after morphine initiation between the two groups, but the concomitant use of continuous midazolam and morphine was more common in the IP group than in the LC group. The dose of continuous midazolam was significantly higher in the IP group than in the LC group, and the survival time after morphine initiation was significantly shorter in the IP group.Conclusions: The efficacy of continuous morphine administration for terminal dyspnea in IP patients was similar to that in LC patients for a short time after initiation, but just before death, more patients in the IP group required concomitant use of midazolam and morphine. Thus, IP patients require comparable or more palliative treatment than LC patients.

Nurses’ Experience in the Introduction of Palliative Sedation for Patients with Terminal Lung Cancer in Respiratory Medicine Wards

Nurses’ Experience in the Introduction of Palliative Sedation for Patients with Terminal Lung Cancer in Respiratory Medicine Wards

Palliative and high-intensity end-of-life care in schizophrenia patients with lung cancer: results from a French national population-based study.

Schizophrenia is marked by inequities in cancer treatment and associated with high smoking rates. Lung cancer patients with schizophrenia may thus be at risk of receiving poorer end-of-life care compared to those without mental disorder. The objective was to compare end-of-life care delivered to patients with schizophrenia and lung cancer with patients without severe mental disorder. This population-based cohort study included all patients aged 15 and older who died from their terminal lung cancer in hospital in France (2014-2016). Schizophrenia patients and controls without severe mental disorder were selected and indicators of palliative care and high-intensity end-of-life care were compared. Multivariable generalized log-linear models were performed, adjusted for sex, age, year of death, social deprivation, time between cancer diagnosis and death, metastases, comorbidity, smoking addiction and hospital category. The analysis included 633 schizophrenia patients and 66,469 controls. The schizophrenia patients died 6years earlier, had almost twice more frequently smoking addiction (38.1%), had more frequently chronic pulmonary disease (32.5%) and a shorter duration from cancer diagnosis to death. In multivariate analysis, they were found to have more and earlier palliative care (adjusted Odds Ratio 1.27 [1.03;1.56]; p = 0.04), and less high-intensity end-of-life care (e.g., chemotherapy 0.53 [0.41;0.70]; p < 0.0001; surgery 0.73 [0.59;0.90]; p < 0.01) than controls. Although the use and/or continuation of high-intensity end-of-life care is less important in schizophrenia patients with lung cancer, some findings suggest a loss of chance. Future studies should explore the expectations of patients with schizophrenia and lung cancer to define the optimal end-of-life care.

Uncertainty and certain death: the role of clinical trials in terminal cancer care.

We consider uncertainty in relation to clinical trials for terminal non-small cell lung cancer, which is an aggressive and difficult to treat form of cancer. Using grounded theory to analyse 85 clinical interactions between doctors, patients and family members, we argue that uncertainty is a major source of tension for terminally ill patients, with individuals confronting a choice between transitioning to palliative care or volunteering for an experimental/trial medication that might postpone death. Regardless of their efficacy, patients must also consider how such experimental treatments might impact their quality-of-life. We argue that clinical trials produce uncertainty through (i) discussions about the efficacy of clinical trials; (ii) the physiological consequences of clinical trial medications; and (iii) the impact clinical trials have on patient's prognostic understanding of their terminal cancer. Accordingly, while study participants encounter high prognostic certainty (i.e. they have a fatal cancer), they nonetheless experience considerable uncertainty in relation to their participation in clinical trials.

P3.15-15 ALI Could Be a One of Prognostic Survival Factor for Non-Small Cell Lung Cancer Patients

Patients with terminal non-small cell lung cancer become greatly concerned about where they will die. And the Advanced Lung Cancer Inflammation Index (ALI, body mass index × albumin/neutrophil-to-lymphocyte ratio) has been demonstrated to be a prognostic factor of survival in some solid cancers. We examined the survival times of such patients according to their place of death; i.e., whether they died at home, at a hospice, or at hospital and analysis with ALI. A retrospective cohort study of patients who were followed from their first chemotherapy session for non-small cell lung cancer until death was performed. Specifically, the study compared four groups, those that died at home, at a hospice, at hospital or alive. The study was based on mortality data from the single institute National Hospital in Japan, for the period between April 2010 and December 2015. Among the 313 patients recruited, 214 were analyzed in this study: 90, 49, and 75 received hospital-based, home-based, and hospice-based palliative care, respectively. The patients who died at a hospice exhibited significantly longer survival than those that died at hospital (estimated median survival time, 420 days [95% confidence interval (CI), 325-612 days] vs. 252 days [95% CI, 201-316 days]; P<0.0001), and the patients that died at home also demonstrated significantly longer survival than those that died at hospital (estimated median survival time, 420 days [95% CI, 325-612 days] vs. 341 days [95% CI, 293-460 days]; P<0.0001). No significant difference in survival was detected between the patients that died at home and those that died at a hospice. At the time of data cut-off, ALI before chemotherapy in 4 groups was evaluated. There was no significant difference in BMI and NLR. However, ALI assessment showed that ALI had a higher value in the surviving patient group with a statistically significant difference from the group who died in the hospital. Patients who died at a hospice or home exhibited significantly longer survival than those that died at hospital. Social background and spiritual factors are also taken into consideration, but ALI before treatment also considered factors that contribute to prognosis.

Abstract 4580: Improved quality of life and tumor regression in a patient with stage IV non-small cell lung cancer with brain metastasis 10 months after daily treatment with single agent mifepristone

Abstract The FDA granted an IND for a 40 patient study entitled “A phase II study of treatment with oral mifepristone as salvage therapy in patients with advanced or metastatic non-small cell lung cancer who have failed 2 or more previous chemotherapy or immunotherapy regimens”. Presented herein is a description of the effect of treating Case 1 who is a 68 year old male who presented with stage IV non-small cell lung cancer with brain metastasis causing seizures following 10 months of treatment with single agent oral mifepristone (Korlym from Corcept Inc) 300mg qd. He had shown tumor progression despite treatment with carboplatin, docetaxel, premetrexed, and gemcitabine. He was not considered a candidate for nivolumab or pembrolizumab because his tumor was negative for the programmed cell death factor ligand 1 (PD-L-1) marker. His preclinical performance status was ECOG 1. After 2 months of daily 300mg mifepristone treatment he showed a considerable improvement in energy and stamina and less shortness of breath. There have been no new lung or brain lesions. In fact, there has been shrinkage of the lung lesions and no growth of the brain lesion and no more seizures. His ECOG was “0” after 10 months of single agent mifepristone treatment. The mechanism of action is believed to be by suppressing intracytoplasmic production of an immunomodulatory protein known as the progesterone induced blocking factor (PIBF). One of the functions of PIBF is to stabilize perforin granules in natural killer cells thus inhibiting their cytotoxic activity. This protein seems to be unique to rapidly growing cells, e.g., trophoblast cells or cancer cells. Thus, in general, in low dosages, as used in this patient, the drug is very well tolerated. PIBF does not seem to be needed for cells growing at normal speed. In humans, mifepristone has been found to either cause complete tumor regression, or more commonly, stabilization of the cancer with improved quality of life. Previously, mifepristone allowed long-term complete remission from a terminal small cell lung cancer with associated hyponaotremia. The case reported here is believed the first involving palliative benefit of treating advanced non-small cell lung cancer with mifepristone. Stabilization of the brain metastasis in this report supports evidence from a previous case of advanced glioblastoma multiforme with a clear though transient response to mifepristone, that the drug can cross the blood-brain barrier, and thus be effective for brain lesions. This is the first case treated with 300mg daily mifepristone (200mg used previously). Similar to the lower dosage, this patient reported no adverse side effects. Mifepristone was also found to improve longevity and body conditioning scores in a placebo controlled study of spontaneous murine lung cancer. Citation Format: Jerome H. Check, Diane Check, Mahmoud Aly, Patricia Lofberg, Rachael Cohen, Dwight McKee. Improved quality of life and tumor regression in a patient with stage IV non-small cell lung cancer with brain metastasis 10 months after daily treatment with single agent mifepristone [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4580. doi:10.1158/1538-7445.AM2017-4580

PUB074 Intake of Cold High Dissolved Oxygen Mineral Water as Cancer Cure

Section not applicable. Many known cancer treatment methods rely on oxygen and/or ozone cancer treatment by gas and by liquid have demonstrated varying degree of successes. A new innovative approach is being applied relying on nano bubble water with high oxygenated level up to 15 to 20 ppm. Normal dissolved oxygen in water seldom exceed 10 ppm. Dissolved oxygen exceeding 10 ppm is in the form activated oxygen (inside nano bubbles) which has ORP value of +2.5V. Nano bubbles can penetrate all types of human membrane and provide oxygen into cancer cells which will cause cell death while healthy cells will prosper. These nano bubble will contain beneficial levels of dissolved nano nitric oxide which will enlarge bood vessels serrounding the cancer cell clusters which speed up the cure. In combination with fasting (no food intake except water) for 14 days, the human body will conduct self detoxification processes and expell toxins out through urine and excretion. Excretion will stop after 2 to 3 days of fasting. These samples analysis yielded various environmental, growth hormones, pesticides and antibiotics residues. Treatment of terminal lung cancer patients with lung cancers showed either shrinkage or even disappearance. Several representitive lung cancer cure cases will be presented with varied degree of successes. Drastic cancer cures means shorter hospital stays. However, bad living habits like eating fatty food, alhohols, smoking patients may need regular maintenance of drinking high oxygenated water.

希望聴取が困難な終末期肺がん患者に対するADLの観察および非言語的コミュニケーションを用いたリハビリテーション介入がQOLの向上に有用であったと考えられる1例

【緒言】進行がん患者とのリハビリテーション（以下リハビリ）の目的はQOLの向上であり，患者の希望を探ることから始まる．今回，希望聴取が困難な患者へのリハビリの工夫を報告する．【症例】83歳男性，肺腺がん，脳転移．化学療法，放射線療法を施行したが病勢は進行し，全身倦怠感と呼吸困難にて入院，その後当院緩和ケア病棟へ転院した．転院時，食事は自立，トイレ歩行は軽介助で可能だったが，てんかん発作を生じ右片麻痺と意識障害を呈した．ADLは全介助，意思疎通も困難だったが，患者はその状況下でも自分で食べようとした．作業療法士はADLの観察および非言語的コミュニケーションを用いて患者の希望を読み取り，これをもとにリハビリ介入を行った．その結果，より早期に食事動作が獲得され，患者の満足度は向上した．【考察】希望聴取が困難な場合でも，リハビリの知識や技術を活用することで，患者の希望を支えられる可能性が示唆された．

Patients with End-stage Interstitial Lung Disease may have More Problems with Dyspnea than End-stage Lung Cancer Patients.

Introduction:Patients with end-stage interstitial lung disease (ILD) do not appear to receive adequate palliative care despite apparent suffering before death. The aim of this study was to evaluate their signs, symptoms, and treatment received before death.Methods:Patients with ILD and lung cancer (LC) who were hospitalized and died in our hospital were enrolled retrospectively. Signs and symptoms and treatments at 7 days, 3 days, and 1 day before death were evaluated and compared between the two groups of patients.Results:A total of 23 patients with ILD and 59 patients with LC group were eligible for participation. Significantly more LC patients had loss of consciousness than ILD patients on 7 days (ILD: LC = 1 [5.6%]:24 [41%], P = 0.013), 3 days (1 [5.6%]:33 [56%], P < 0.001). Significantly more ILD patients had dyspnea than LC patients on 3 days (16 [89%]:38 [64%], P = 0.047) 1 day before death (21 [91%]:33 [56%], P = 0.001). On 1 day before death, significantly more LC patients received morphine than ILD patients (2 [8.7%]: 14 [24%], P = 0.015). More ILD patients received sedation (11 [48%]: 11 [19%], P = 0.007).Conclusions:End-stage ILD patients may experience dyspnea more frequently than terminal LC patients, and they need sedation. Morphine should be administered to ILD patients who have dyspnea. Additional prospective studies are needed.