• Stacey J Butler, Alexander V Louie, Rinku Sutradhar, Lawrence Paszat, Dina Brooks, and Andrea S Gershon.
• 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.
• J Pain Symptom Manage. 2023 Dec 1; 66 (6): 611620.e4611-620.e4.

ContextLung cancer patients with chronic obstructive pulmonary disease (COPD) may have greater palliative care needs due to poor prognosis and symptom burden.ObjectivesWe sought to compare the provision of timely palliative care and symptom burden by COPD status.MethodsWe 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.ResultsA 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.ConclusionCOPD 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.Copyright © 2023 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

17 keywords...

hide…