COPD, IPF end of life health care use differs from lung cancer
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Key takeaways:
- The likelihood for end-of-life outpatient palliative care and opioids was decreased among those with COPD or IPF.
- In contrast, the odds for intensive care and mechanical ventilation were increased.
SAN DIEGO — Six months before dying, patients with COPD and idiopathic pulmonary fibrosis vs. lung cancer had reduced odds for outpatient palliative care, according to a poster at the American Thoracic Society International Conference.
“We were surprised by the extreme differences in end-of-life palliative care use in COPD and IPF compared to lung cancer,” Angela O. Suen, MD, clinical instructor and research fellow in the division of pulmonary, critical care, allergy and sleep medicine at UCSF, told Healio.
These findings were particularly surprising “in a health care system in which robust palliative care services are available to oncologic and non-oncologic diagnoses,” she continued.
Using records of outpatient/inpatient visits at the University of California, San Francisco (UCSF), Suen and colleagues assessed 1,543 patients with lung cancer, 1,004 patients with COPD and 530 patients with IPF, all of whom had died, to see how palliative care and health care use during the patients’ final 6 months differed between those with lung cancer and those with either COPD or IPF.
The COPD and IPF cohorts significantly differed (P < .001) from the lung cancer cohort on accounts of age at death, sex, race/ethnicity and comorbidity burden, according to researchers.
“Compared to the lung cancer group, patients with COPD and IPF were more likely to be white, male, older at the time of death and have a lower burden of comorbidities,” Suen and colleagues wrote.
Following adjustment for age, sex, race/ethnicity and weighted Charlson comorbidity index, the likelihood for outpatient palliative care was significantly reduced among those with COPD vs. those with lung cancer (adjusted OR = 0.34; 95% CI, 0.26-0.45), as was the likelihood for outpatient opioids (aOR = 0.52; 95% CI, 0.42-0.65).
Researchers observed similar findings when evaluating patients with IPF vs. patients with lung cancer in terms of odds for outpatient palliative care (aOR = 0.53; 95% CI, 0.37-0.74) and odds for outpatient opioids (aOR = 0.42; 95% CI, 0.31-0.55).
In contrast, patients with IPF faced elevated likelihoods for four assessed outcomes when placed against patients with lung cancer, including:
- intensive care (aOR = 3.75; 95% CI, 2.65-5.31);
- mechanical ventilation (aOR = 3.22; 95% CI, 2.18-4.75);
- high flow nasal oxygen (aOR = 2.87; 95% CI, 1.91-4.32); and
- inpatient palliative care consultation (aOR = 2.26; 95% CI, 1.59-3.21).
The odds for intensive care were also heightened among those with COPD vs. those with lung cancer (aOR = 2.13; 95% CI, 1.65-2.75), according to researchers. The only other outcome patients with COPD had an increased likelihood for vs. patients with lung cancer was mechanical ventilation (aOR = 1.94; 95% CI, 1.41-2.67).
“Overall, we learned that there is more work to be done to understand this discrepancy so that we may be able to address this,” Suen said.