Palliative care Department, Institut Curie, Paris, France.
Biostatistics Department, Institut Curie, Paris, France.
Lung Cancer. 2024 Jun;192:107800. doi: 10.1016/j.lungcan.2024.107800. Epub 2024 Apr 24.
Non-small cell lung cancer (NSCLC) without oncogenic driver mutations is considered to have a poor prognosis, although recent therapeutic progress. This study aims to assess the real-life integration of palliative care (PC) and the intensity of end-of-life (EOL) care for this population.
This was an observational cohort study of decedent patients from metastatic NSCLC without oncogenic driver mutations over the period 01/2018 to 12/2022, treated in first line with immunotherapy +/- chemotherapy. We analysed PC integration and aggressiveness criteria of EOL care in the last month before death: systemic anti-cancer treatment administration, emergency room visits, intensive care unit admission, hospitalization, hospitalization duration > 14 days, and hospital death.
Among 149 patients, 75 (50 %) met the PC team at least once, and the median time from the first encounter to death was 2.3 months. In the last month before death, at least one criterion of aggressive EOL care was present for 97 patients (70 %). For patients with PC use < 30 days and for patients with PC use < 90 days before death, there were significant changes: increase in the frequency of systemic anti-cancer treatment (respectively 51.1 % vs 20 %; p < 0.001 and 58.7 % vs 6.2 %; p < 0.001); decrease in hospitalization lasting > 14 days (respectively 30 % vs 7 %; p = 0.001 and 36 % vs 6.2 %; p = 0.018) and in death hospitalisation (respectively 66 % and 18 %; p < 0.001 and 58.7 % and 10.3 %; p < 0.001). After adjusting for the factors tested, patients with no PC or late PC use in the last month before death or in the last three month before death, the odds ratio (OR) remained significantly greater than 1 (respectively OR = 3.97 [1.70; 9.98]; p = 0.001 and OR = 23.1 [5.21-177.0], p < 0.0001).
PC is still insufficiently integrated for patients with NSCL cancer. Cancer centres should monitor key indicators such as PC use and aggressiveness criteria of EOL care.
尽管最近有了治疗进展，但没有致癌驱动突变的非小细胞肺癌（NSCLC）仍被认为预后不良。本研究旨在评估这一人群的姑息治疗（PC）实际整合和生命终末期（EOL）护理的强度。
这是一项观察性队列研究，纳入了在 2018 年 1 月至 2022 年 12 月期间接受一线免疫治疗+/-化疗治疗的转移性 NSCLC 且无致癌驱动突变的死亡患者。我们分析了最后一个月死亡前 PC 整合和 EOL 护理的侵袭性标准：全身抗癌治疗、急诊就诊、重症监护病房入院、住院、住院时间>14 天和医院死亡。
在 149 名患者中，有 75 名（50%）至少接受过一次 PC 团队的治疗，从首次就诊到死亡的中位时间为 2.3 个月。在死亡前的最后一个月，有 97 名患者至少存在一项 EOL 护理的侵袭性标准（70%）。对于 PC 使用<30 天和 PC 使用<90 天的患者，有显著变化：全身抗癌治疗的频率增加（分别为 51.1%比 20%；p<0.001 和 58.7%比 6.2%；p<0.001）；住院时间>14 天的比例减少（分别为 30%比 7%；p=0.001 和 36%比 6.2%；p=0.018）和住院死亡的比例减少（分别为 66%和 18%；p<0.001 和 58.7%和 10.3%；p<0.001）。在校正了所测试的因素后，在死亡前最后一个月或最后三个月内没有 PC 或 PC 使用较晚的患者，其比值比（OR）仍显著大于 1（分别为 OR=3.97[1.70;9.98]；p=0.001 和 OR=23.1[5.21-177.0]，p<0.0001）。
PC 对于 NSCLC 患者的整合仍然不足。癌症中心应监测 PC 使用和 EOL 护理侵袭性标准等关键指标。
