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Abstract
This study was conducted to characterize the aggressiveness of end-of-life care in patients with lung cancer in an oncology department in Hong Kong.
Methods: This retrospective cohort composed of patients diagnosed with locally advanced or metastatic lung cancer and received primary treatment from 2007-2009. 216 patients who died of lung cancer within the studied period were evaluated in terms of aggressiveness of cancer-care in end-of-life.
Results: One hundred and forty of the 216 patients (64.8%) underwent palliative chemotherapy. 16.4% started a new chemotherapy regimen within 30 days of death and 22.1% received chemotherapy within 14 days of death. 22.9% experienced grade 3/4 toxicities and 21.4% were admitted at least twice during last line of treatment. By multivariate analysis, more extensive disease, age less than 65 and longer survival from diagnosis was positively associated with chemotherapy use. Patients with reasonable performance status were more likely to receive chemotherapy within 14 days of death. 135 patients (62.5%) had been referred to hospice and around twenty percent of patient stayed in hospice before death for 3 days or fewer. For other indicators of aggressive end-of-life care, 20% were admitted to acute bed and 24.5% visited emergency room at least twice in last month of life.
Conclusion: Among patients who died of lung cancer, a significant proportion was found to receive palliative chemotherapy near end-of-life. This can be contributed by the increase in availability of new chemotherapy options. Improvement in hospice service and development of simultaneous care model allows high-quality end-of-life care.
Keywords: Cancer, oncology, lung cancer, end-of life.
Introduction
In years, cancer continues to be a major public health burden in Hong Kong and accounts for about one third of the death in 2006 (1). There has been a growing incidence and prevalence of cancer globally due to aging population. Yet, despite the advances in cancer detection and treatment, many patients still present at a more advanced and incurable stage, and eventually died of cancers. Chemotherapy for metastatic solid tumours rarely if ever cures patients. But these patients may still benefit from symptom control, minimization or prevention of complications, improving quality of life and even prolongation of survival. However, the expansion of therapeutic possibilities, combined with primary goal of medical care to restore or maintain...