Place of Death in patients with Advanced Non-small Cell Lung Carcinoma (NSCLC) in South Western Sydney
Kirsten Duggan, Jennifer Wiltshire, Rebecca Strutt, Miriam Boxer, Angela Berthelsen, Joseph Descallar, Shalini Vinod.
Liverpool Hospital, NSW, Australia
Background:
Patients with advanced NSCLC have a limited life expectancy. Appropriate End of Life (EOL) care is one measure of quality of care in these patients. This includes suitable location of death to minimise unnecessary interventions which may occur in an acute care setting.
Aim:
To identify patterns in location of death and factors associated with each location, to indicate quality care at EOL.
Method:
Deceased patients diagnosed with Stage IV NSCLC between 2006-2012 were identified from the Area Cancer Registry. Death locations were categorised into Palliative Care (PC) and Acute Care (AC) hospital settings, and Other Death Locations (ODL); which included Aged-Care Facility and Home deaths. Patient, tumour and treatment data were analysed to identify associations with each location using multinomial regression models.
Results:
886 patients were identified. 63% of patients were male, with a median age of 69 years. 53% were born overseas and 25% preferred non-English languages. 65% received anti-cancer treatment. Most patients died in a PC setting (43%), followed by AC (37%). 12% of AC deaths occurred within the Emergency Department or Intensive Care Units. Patients aged over 84 years and those who received active treatment were less likely to die in AC. Non-English speakers had significantly increased odds of dying in AC settings.
Conclusion:
A significant number of patients with stage IV lung cancer died in AC settings suggesting the need for improvement, with greater involvement of the palliative care team. The relatively high number of deaths in ICU and emergency requires further analysis and investigation into the increased AC deaths for Non-English speaking patients is recommended.