Palliative care integration and end-of-life care intensity for patients with NSCLC

A Martin; M Carton; L Thery; A Burnod; C Daniel; P Du Rusquec; N Girard; C Bouleuc

doi:10.1016/j.lungcan.2024.107800

Palliative care integration and end-of-life care intensity for patients with NSCLC

Lung Cancer. 2024 Apr 24:192:107800. doi: 10.1016/j.lungcan.2024.107800. Online ahead of print.

Authors

A Martin¹, M Carton², L Thery¹, A Burnod¹, C Daniel³, P Du Rusquec³, N Girard³, C Bouleuc⁴

Affiliations

¹ Palliative care Department, Institut Curie, Paris, France.
² Biostatistics Department, Institut Curie, Paris, France.
³ Oncology Department, Institut Curie, Paris, France.
⁴ Supportive care Department, Institut Curie, Paris, France. Electronic address: carole.bouleuc@curie.fr.

PMID: 38728972
DOI: 10.1016/j.lungcan.2024.107800

Abstract

Background: Non-small cell lung cancer (NSCLC) without oncogenic driver mutations is considered to have a poor prognosis, although recent therapeutic progress. This study aims to assess the real-life integration of palliative care (PC) and the intensity of end-of-life (EOL) care for this population.

Methods: This was an observational cohort study of decedent patients from metastatic NSCLC without oncogenic driver mutations over the period 01/2018 to 12/2022, treated in first line with immunotherapy +/- chemotherapy. We analysed PC integration and aggressiveness criteria of EOL care in the last month before death: systemic anti-cancer treatment administration, emergency room visits, intensive care unit admission, hospitalization, hospitalization duration > 14 days, and hospital death.

Results: Among 149 patients, 75 (50 %) met the PC team at least once, and the median time from the first encounter to death was 2.3 months. In the last month before death, at least one criterion of aggressive EOL care was present for 97 patients (70 %). For patients with PC use < 30 days and for patients with PC use < 90 days before death, there were significant changes: increase in the frequency of systemic anti-cancer treatment (respectively 51.1 % vs 20 %; p < 0.001 and 58.7 % vs 6.2 %; p < 0.001); decrease in hospitalization lasting > 14 days (respectively 30 % vs 7 %; p = 0.001 and 36 % vs 6.2 %; p = 0.018) and in death hospitalisation (respectively 66 % and 18 %; p < 0.001 and 58.7 % and 10.3 %; p < 0.001). After adjusting for the factors tested, patients with no PC or late PC use in the last month before death or in the last three month before death, the odds ratio (OR) remained significantly greater than 1 (respectively OR = 3.97 [1.70; 9.98]; p = 0.001 and OR = 23.1 [5.21-177.0], p < 0.0001).

Conclusion: PC is still insufficiently integrated for patients with NSCL cancer. Cancer centres should monitor key indicators such as PC use and aggressiveness criteria of EOL care.

Keywords: Early palliative care; End-of-life care; Metastatic non-small cell lung cancer; Systemic cancer treatment discontinuation.