Lung Disease at End-of-Life

Bottom Line: I struggle with navigating "what's best" for patients approaching the end-of-life with advanced lung disease. I fully believe in the hospice approach to care and the benefits of a patient-centered approach to any patient approaching the last months of life. I also fully believe in the process of calling EMS for severe respiratory distress and the benefits of non-invasive positive pressure ventilation brought upon in a timely manner that is nearly impossible to be done by a hospice team. For this reason, any discussion about hospice for advanced lung disease really prompts me to explore what a patient is looking for as they approach their dying process.

As it stands, I don't know if I can appreciate this piece as one that is generalizable to the US population. The study at hand is a cross-sectional study of adults with COPD and lung cancer who died in a public hospital in Portugal from 2010-2015. Data was gathered from the Hospital Morbidity Database and based on physician coding under ICD-9-CM codes to account for identifying individuals who were hospitalized in the last month of life and carried diagnoses of either COPD or lung cancer (those with both were excluded).

The rudimentary conclusion is that, at the end-of-life (designated as the last month of life) patients with lung cancer had longer hospitalizations than patients with COPD at the end of life (hospitalizations >14 days, OR = 1.12; CI = 1.00-1.25). When evaluating this on a percentage, it was found that of those patients hospitalized, 40.0% of patients with lung cancer were hospitalized for greater than 14 days compared to 36% of patients with COPD. I can always appreciate statistical significance, but I do question the clinical significance here. I think this piece is more interesting from a public health perspective, as it identified how sex, hospital size, bed availability in palliative care units, and the urbanization level of a patient's residence location played significant roles to account for differences in hospitalizations. At the end of the day, I can appreciate that as a whole we are still struggling to identify how patients in the terminal course of their illness trajectory approach their care, and that more data is more data. I won't be making any significant changes to my care, but I will continue to realize the difficulty patients face at the end of life when dealing with advanced lung disease.

Costa, Ana Rute, et al. "Hospitalizations at the End of Life Among Chronic Obstructive Pulmonary Disease and Lung Cancer Patients: A Nationwide Study." Journal of Pain and Symptom Management 62.1 (2021): 48-57.