Aggressive Care Associated With Poorer Outcomes for Patients With NSCLC at End of Life

Aggressive care in the last month of life for patients with non–small cell lung cancer (NSCLC) is associated with lower family evaluations of end-of-life care.

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Patients with advanced NSCLC who are nearing end-of-life often undergo aggressive care involving chemotherapy, mechanical ventilation, acute hospitalizations, and intensive care unit admissions. However, limited research has examined the relationship between patients’ and families’ satisfaction with aggressive care within the last 30 days of life.

Mary Ersek, PhD, RN, FPCN, University of Pennsylvania School or Nursing, and colleagues conducted a study to examine the associations between aggressive care at end-of-life and families’ evaluations of such care among patients with NSCLC. A total of 847 patients with NSCLC who died in a nursing home or intensive care, acute care, or hospice care unit across 128 Veterans Affairs Medical Centers between 2010 and 2012 were examined. Researchers administered a Bereaved Family Survey, to which they received a 62% response rate. Results of the study were published in Cancer (published online April 2017; doi:10.1002/cncr.30700).

Investigators found that more than 72% of veterans with advanced NSCLC had at least one episode of aggressive care in the last 30 days of life (defined as receipt of injectable chemotherapy or mechanical ventilation) or more than two hospitalizations or admissions to an intensive care unit. For patients who experienced at least one episode of aggressive care, bereaved families rated care lower compared with those patients who did not receive any aggressive care.

Among patients dying in a hospice care unit, associations between ratings of care and more than two inpatients
admissions or any episode of aggressive care were not found to be significant.

Additionally, researchers noted that rates of aggressive care were not associated with age; bereaved family ratings of care were similar for younger and older patients. This finding may have reflected the Veteran Affair’s adoption of “concurrent care,” which allows patients to receive simultaneous disease-modifying treatments with hospice care.

Implications of the study suggest that specialized care provided within a hospice care unit may help mitigate the negative effects of aggressive care. “It is important to give patients with advanced illness options for care, including concurrent care. However, we need to be mindful that aggressive care at the end of life is not associated with better patient outcomes, and guide patients accordingly,” said Dr Ersek in a press release (May 25, 2017). “Regardless of the treatment that patients choose, we need to be offering hospice and palliative care services.”—Zachary Bessette