Palliative Care Among Lung Cancer Patients With and Without COPD: A Population-Based Cohort Study

Stacey J Butler; Alexander V Louie; Rinku Sutradhar; Lawrence Paszat; Dina Brooks; Andrea S Gershon

doi:10.1016/j.jpainsymman.2023.08.017

Palliative Care Among Lung Cancer Patients With and Without COPD: A Population-Based Cohort Study

J Pain Symptom Manage. 2023 Dec;66(6):611-620.e4. doi: 10.1016/j.jpainsymman.2023.08.017. Epub 2023 Aug 22.

Authors

Stacey J Butler¹, Alexander V Louie², Rinku Sutradhar³, Lawrence Paszat⁴, Dina Brooks⁵, Andrea S Gershon⁶

Affiliations

¹ Institute of Medical Sciences (S.J.B., A.S.G.), University of Toronto, Toronto, ON, Canada; ICES (S.J.B., R.K., L.P., A.S.G.), Toronto, ON, Canada; Sunnybrook Research Institute (S.J.B., A.V.L., R.S., L.P., A.S.G.), Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
² Sunnybrook Research Institute (S.J.B., A.V.L., R.S., L.P., A.S.G.), Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
³ ICES (S.J.B., R.K., L.P., A.S.G.), Toronto, ON, Canada; Sunnybrook Research Institute (S.J.B., A.V.L., R.S., L.P., A.S.G.), Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Dalla Lana School of Public Health (R.S.), University of Toronto, Toronto, ON, Canada.
⁴ ICES (S.J.B., R.K., L.P., A.S.G.), Toronto, ON, Canada; Sunnybrook Research Institute (S.J.B., A.V.L., R.S., L.P., A.S.G.), Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Health Policy (L.P., ASG), Management and Evaluation, University of Toronto, Toronto, ON, Canada.
⁵ School of Rehabilitation Sciences (D.B.), McMaster University, Hamilton, ON, Canada.
⁶ Institute of Medical Sciences (S.J.B., A.S.G.), University of Toronto, Toronto, ON, Canada; ICES (S.J.B., R.K., L.P., A.S.G.), Toronto, ON, Canada; Sunnybrook Research Institute (S.J.B., A.V.L., R.S., L.P., A.S.G.), Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Institute of Health Policy (L.P., ASG), Management and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address: andrea.gershon@ices.on.ca.

PMID: 37619760
DOI: 10.1016/j.jpainsymman.2023.08.017

Abstract

Context: Lung cancer patients with chronic obstructive pulmonary disease (COPD) may have greater palliative care needs due to poor prognosis and symptom burden.

Objectives: We sought to compare the provision of timely palliative care and symptom burden by COPD status.

Methods: We performed a retrospective, population-based cohort study of individuals diagnosed with lung cancer in Ontario, Canada (2009-2019) using health administrative databases and cancer registries. The impact of COPD on the probability of receiving palliative care was determined accounting for dying as a competing event, overall and stratified by stage. The provision of palliative care for patients with severe symptoms (Edmonton Symptom Assessment Scale score ≥ 7), location of the first palliative care visit and symptom severity were compared by COPD status.

Results: A total of 74,993 patients were included in the study (48% of patients had available symptom data). At the time of lung cancer diagnosis, 50% of patients had COPD. Stage I-III patients with COPD were more likely to receive palliative care (adjusted Hazard Ratio (HR)s: 1.05-1.31) with no difference for stage IV (1.02, 95% CI: 1.00-1.04). Despite having severe symptoms, very few patients with early-stage disease received palliative care (Stage I: COPD-23% vs. no COPD-18%, SMD = 0.12). Most patients (84%) reported severe symptoms and COPD worsened symptom burden, especially among early-stage patients.

Conclusion: COPD impacts the receipt of palliative care and symptom burden for patients with early-stage lung cancer. Many patients with severe symptoms did not receive palliative care, suggesting unmet needs among this vulnerable population.

Keywords: COPD; Lung cancer; palliative care; symptoms.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cohort Studies
Humans
Lung Neoplasms* / epidemiology
Lung Neoplasms* / therapy
Ontario / epidemiology
Palliative Care
Pulmonary Disease, Chronic Obstructive* / epidemiology
Pulmonary Disease, Chronic Obstructive* / therapy
Retrospective Studies

Grants and funding

CIHR/Canada