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The following is a summary of “Differences in Healthcare and Palliative Care Utilization at the End of Life: a Comparison Study Between Lung Cancer, COPD, and IPF,” published in the August 2024 issue of Pulmonology by Suen et al.
Patients with lung cancer, idiopathic pulmonary fibrosis (IPF), and chronic obstructive pulmonary disease (COPD) often experience significant symptom burden, diminished quality of life, and high healthcare utilization near the end of life. Although proactive palliative care integration is known to enhance outcomes for patients with lung cancer, similar practices for COPD and IPF remain underexplored. This study aimed to compare healthcare utilization and palliative care patterns between patients with these conditions in their final six months of life.
The researchers conducted a retrospective analysis of deceased patients with lung cancer, COPD, or IPF who had at least one outpatient visit at [removed] in their last six months. The study group examined and compared rates of outpatient palliative care and opioid prescriptions, inpatient palliative care, hospitalizations, intensive care unit (ICU) admissions, and in-hospital deaths across the three groups. Multivariable logistic regression was employed to adjust for confounding variables, with lung cancer as the reference group.
The cohort included 1,819 patients, with those having COPD and IPF being notably older and predominantly male compared to their lung cancer counterparts. Analysis revealed that patients with COPD and IPF had significantly lower adjusted odds of receiving outpatient palliative care (COPD aOR: 0.26, 95% CI: 0.19-0.36; IPF aOR: 0.48, 95% CI: 0.32-0.70) and outpatient opioids (COPD aOR: 0.50, 95% CI: 0.40-0.63; IPF aOR: 0.40, 95% CI: 0.29-0.54) compared to patients with lung cancer (p < 0.001). Conversely, these patients exhibited higher adjusted odds of ICU utilization in their final days (COPD aOR: 2.88, 95% CI: 2.11-3.93; IPF aOR: 4.15, 95% CI: 2.66-6.49). Notably, patients with IPF had higher odds of receiving inpatient palliative care (aOR: 2.02, 95% CI: 1.30-3.13, p = 0.002) than the lung cancer group.
In conclusion, patients with COPD and IPF generally receive less outpatient palliative care and opioid treatment. They are more likely to experience ICU admissions at the end of life compared to patients with lung cancer. The findings highlight the need for improved palliative care integration in COPD and IPF management to align with practices seen in lung cancer care.
Source: sciencedirect.com/science/article/abs/pii/S0012369224050499
