More research needed to tailor palliative care for advanced COPD

In a new study, palliative care was associated with a modest increase in at-home mortality among patients with advanced COPD but did not reduce days at home or health care use compared with those who did not receive palliative care.

“We found that conventional palliative care did not help people with COPD spend more days at home, but it did seem to result in more people with COPD dying at home,” Andrea S. Gershon, MD, MSc, senior core scientist at ICES and the Sunnybrook Research Institute, respirologist in the division of respirology at Sunnybrook Health Sciences Centre and associate professor of medicine at the University of Toronto, told Healio. “Further, it did not seem to result in less people with COPD receiving acute care; this finding can be used to reassure patients that acceptance of a palliative care approach does not mean forgoing the opportunity for acute care intervention.”

The researchers identified 35,492 patients with advanced COPD who were hospitalized from April 2010 to March 2017 in Ontario, Canada. All patients were followed until March 2018. Patients who received palliative care (n = 1,788; mean age, 78 years; 51.5% men) were matched by age, sex, long-term oxygen, previous COPD hospitalizations and propensity scores with patients who did not receive palliative care (n = 33,704; mean age, 73.8 years; 48.4% men).

In the matched cohort of 1,721 pairs, patients who received palliative care had similar rates of days at home compared with those who did not receive palliative care (RR = 1.01; 95% CI, 0.97-1.05). In addition, the rate of patients who died at home was higher among those who received palliative care compared with those who did not receive palliative care (16.4% vs. 10%; P < .001).

“The findings were somewhat surprising as we had anticipated that palliative care may have been associated with more days spent at home,” Gershon said. “The findings of the study point to the need to develop palliative care approaches that are tailored to the needs of people with COPD.”

Rates of health care use were also similar between both those who received palliative care and those who did not for all-cause acute care hospitalizations (1.37 vs. 1.26, COPD-related acute care hospitalizations (0.65 vs. 0.57), ICU stays (0.19 vs. 0.19), ED visits (1.46 vs. 1.47) and COPD-related ED visits (0.37 vs. 0.35). However, researchers observed higher rates of all-cause hospitalization (1.37 vs. 1.26 per person-year; RR = 1.09; 95% CI, 1.01-1.18) and COPD-related hospitalization (0.65 vs. 0.57 per person-year; RR = 1.13; 95% CI, 1.01-1.26) among patients who received palliative care compared with patients who did not receive palliative care.

“We found that conventional palliative care is not a large help for people with COPD,” Gershon told Healio. “More research is needed to determine how palliative care can be tailored to meet the needs of this population.”

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Andrea S. Gershon, MD, MSc, can be reached at andrea.gershon@ices.on.ca.