Palliative Care and End of Life Issues |

End of Life Care in Oxygen-Dependent Pulmonary Fibrosis Compared to Cancer: A National Population-Based Study FREE TO VIEW

Nicholas Wysham, MD; Zainab Ahmadi; Magnus Ekström, MD
Author and Funding Information

Pulmonary and Critical Care, Duke University, Durham, NC: Lund University Hosptial, Lund, Sweden

Chest. 2015;148(4_MeetingAbstracts):773A. doi:10.1378/chest.2249896
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SESSION TITLE: Palliative Care and End of Life Issues Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Pulmonary fibrosis (PF) is an often progressive, unpredictable, and ultimately fatal condition. Improving end of life (EOL) care and the role of palliative care in PF patients has recently gained recognition, though little is known about these patients’ symptom burdens at EOL, access of palliative care services, and quality of EOL care.

METHODS: Patients with PF who died From January 1, 2011 through October 14, 2013 were identified by cross-linking individual patient identifiers from nationwide Swedish registries of long-term oxygen therapy (LTOT) and EOL care: Swedevox and Swedish Registry of Palliative Care (SRPC). Patients in the SRPC registry who died of cancer in the same time period served as a comparator group to characterize differences in EOL care. We abstracted baseline demographics, pulmonary function at time of LTOT initiation, place of death, prevalence of symptoms at EOL, and symptom relief.

RESULTS: 285 patients with PF and 56,843 with terminal cancer were identified. PF were slightly older than cancer patients: 78± 8, 75± 12 years respectively (p<0.001). A smaller percentage of PF patients were women (39% v 49%, p=0.002). Death was more likely to be unexpected for PF patients (15% v 4%, p<0.001). PF patients were less likely to have died in a palliative care setting (17% v 39%) and more often died in a non-palliative hospital ward (46% v 28%, p<0.001). Breathlessness (75% v. 25%, p<0.001) and anxiety (66% v. 54%, p<0.001) were more common at the EOL for PF patients, whereas pain (52% v 81%, p<0.001) and nausea (14% v. 23%, p=0.003) was more common for cancer patients. Cancer patients were more likely to experience relief of dyspnea, pain, and anxiety.

CONCLUSIONS: PF patients access fewer palliative care services and experience greater symptom burden at the EOL than patients with terminal cancer.

CLINICAL IMPLICATIONS: While these observed differences are likely related in part to disease-specific characteristics, our findings suggest opportunities to improve EOL care for patients with PF.

DISCLOSURE: The following authors have nothing to disclose: Nicholas Wysham, Zainab Ahmadi, Magnus Ekström

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