End-of-life symptom management in lung cancer patients quantified

  • Saphire M & al.
  • J Pain Symptom Manage
  • 25 Nov 2019

  • curated by Kelli Whitlock Burton
  • Univadis Clinical Summaries
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Takeaway

  • Symptom management medications are common during the end-of-life (EOL) period in patients with lung cancer in an outpatient, nonhospice setting, with dyspnea, pain, and emotional distress the most commonly reported symptoms.

Why this matters

  • Although less than half of Medicare patients enroll in hospice, there are few data on EOL care in Medicare participants outside a hospice setting.

Study design

  • 16,246 Medicare recipients who were diagnosed with lung cancer and who died between 2008 and 2013.
  • Funding: Lung Cancer Research Foundation.

Key results

  • 62.5% received pain medication and 49.4% treatment for emotional distress, 70.7% for dyspnea, 19.9% for fatigue, 21.4% for anorexia, and 19.2% for vomiting/nausea.
  • The number of patients receiving symptom management medications increased from 6 months before death to the last month:
    • Dyspnea: 61.1% vs 80.1%.
    • Pain: 42.6% vs 63.3%.
    • Emotional distress: 37.8% vs 48.9%.
    • Fatigue: 13.0% vs 20.8%.
    • Anorexia: 5.1% vs 17.3%.
    • Nausea/vomiting: 10.0% vs 19.6%.
    • Oral corticosteroids: 10.3% vs 30.1%.
  • Symptom management medication was more likely in women, people with dual Medicaid enrollment, and those receiving concurrent cancer treatment, and less likely among older patients and those who were black, Hispanic, or Asian.

Limitations

  • Retrospective study.