Understanding quality-of-life in older adults with advanced lung cancer: Comparisons of three care models

Abstract

Older adults with advanced metastatic lung cancer are faced with both poor prognosis and options for cancer-directed therapies very late into their disease trajectory. This trend of increasing chemotherapy close to death in older cancer patients continues to grow resulting in unmet psychosocial and existential needs at the end-of-life for patients who choose to continue cancer-directed therapies. The present study is grounded in an existential and social constructionist perspective which characterizes the either/or choice of late-stage cancer treatment or palliative care through a hospice program as an existential conflict within a context of socially constructed options for end-of-life care.

This observational study examined differences among three groups of older advanced lung cancer patients (N = 30) to determine whether simultaneous care patients have better psychosocial and existential quality-of-life at the end-of-life than patients receiving only cancer-directed therapy or routine hospice care. Simultaneous care refers to a care model in which patients with late-stage cancer receive cancer-directed therapy and routine hospice services concurrently. Quality-of-life at the end-of-life represents developmental tasks and concerns associated with preparation for death and life closure. Participants were recruited from a Veterans Affairs Medical Center oncology clinic and a non-profit community hospice.

Nonparametric statistics examined the study’s primary hypothesis whether simultaneous care makes a difference in quality-of-life at the end-of-life compared to conventional care models such as cancer-directed therapy or routine hospice care. The primary hypothesis was not supported in the present study, although subgroup analyses based on demographic variables indicated statistically significant results. These findings support a sense of generativity, interpersonal connection, and having social support in which one can communicate substantial concerns or thoughts as important components of life closure. Methodological challenges within the present study reify cultural influences embedded in oncology practice and society as a whole that continue to support a taboo around dying and death. Efforts to integrate a hospice care model and cancer-directed therapy earlier in a cancer diagnosis face considerable challenges as a result of socially-constructed meanings of hospice. Further study is needed to determine which palliative care models can best meet the psychosocial and existential needs of older advanced lung cancer patients at varying points on the cancer trajectory.