Active Anticancer Treatment During the Final Month of Life in Patients with Non-small Cell Lung Cancer

1. CARSTEN NIEDER¹,²⇑,
2. TERJE TOLLÅLI³,
3. ASTRID DALHAUG¹,²,
4. ELLINOR HAUKLAND¹,
5. GRO AANDAHL¹,
6. ADAM PAWINSKI¹ and
7. JAN NORUM²,⁴,⁵

+ Author Affiliations

1. ¹Department of Oncology and Palliative Medicine, Nordland Hospital, Bodø, Norway
2. ²Institute of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
3. ³Department of Pulmonology, Nordland Hospital, Bodø, Norway
4. ⁴Northern Norway Regional Health Authority, Bodø, Norway
5. ⁵Department of Oncology, University Hospital of North Norway, Tromsø, Norway

1. Correspondence to: Carsten Nieder, MD, Department of Oncology and Palliative Medicine, Nordland Hospital, P.O. Box 1480, 8092 Bodø, Norway. Tel: +47 75578490, Fax: +47 75534975, e-mail: carsten.nieder@nlsh.no

Abstract

Non-small cell lung cancer (NSCLC) is a major cause of cancer-related death and consumption of healthcare resources worldwide.

 Significant costs are generated shortly before death, partly because of continued oncological treatment during the terminal stage of disease. We analyzed factors predicting for the likelihood of active anticancer therapy during the final month of life. Patients who died from NSCLC (any stage and treatment) during the years 2006-2013 within a defined geographical region of northern Norway were included (n=266). Out of these, 28.6% received oncological treatment during the final month of life. Hospital death occurred in 70% of patients who received active treatment during their last month of life, compared to 41% of other patients (p=0.0001). Multivariate analysis showed that lack of documented resuscitation preference (p=0.001) and the presence of superior vena cava compression (p=0.039) were the most important predictors of active therapy during the last month of life. Trends were observed with regard to use of steroids for symptom palliation (p=0.067) and advanced T stage (p=0.071). Given that patients with documented resuscitation preference before their last month of life (typically a do not resuscitate order) were unlikely to receive active treatment during the final month (2% versus 35% in patients without documented preference), early discussion of prognosis, options for symptom control and resuscitation preference are crucial components in strategies for improving terminal care.