Death Places of Lung Cancer Patients and Palliative Care

Öz

Objective: In this study, it was aimed to show that the place of death of patients who died due to lung cancer, shifted to the palliative service, after the establishment of the palliative care service in our hospital. Materials and Methods: The study was conducted as a 4-year retrospective cross-sectional study at the Chest Diseases and Thoracic Surgery Training and Research Hospital between 2017 and 2020. Patients who were diagnosed with lung cancer and died in the hospital during the study period were included in the study. Demographic data of the patients, comorbidities, laboratory values, changes in hospital location, respiratory support (invasive and noninvasive mechanical ventilation, oxygen), medical treatments, places of death and at most four causes of death were recorded from hospital mortality data. Data were summarized by descriptive analysis. Results: During the study period, 15,552 patients were hospitalized due to lung cancer and the number of patients who died from these patients was determined as 1896 (12%). Of the 1896 patients who died, 44% (n=834) had their first hospitalization in palliative care, and only 19 of these patients were referred back to the intensive care unit. There was a statistically significant increase in hospitalization to the palliative service over the years (p<0.001). It was found that applications from external centers increased statistically over the years (p˂0.001). A statistically significant decrease was observed in the non-invasive mechanical ventilation and vasopressor treatment applied to the patients over the years (p<0.001). Conclusion: Effective use of palliative services will lead to a reduction in unnecessary aggressive treatments at the end of life, thus reducing the cost and effective use of intensive care beds. There is a need for studies to increase palliative care awareness that will help determine the country's health policy.

Anahtar Kelimeler

• Lung cancer
• mortality
• intensive care
• palliative care

AKCİĞER KANSERLİ HASTALARIN ÖLÜM YERLERİ VE PALYATİF BAKIM

Öz

Amaç: Bu araştırmada, hastanemizde palyatif bakım servisi kurulduktan sonra akciğer kanseri nedeni ile ölen hastaların ölüm yerlerinin palyatif servise kaydığının gösterilmesi hedeflenmiştir. Gereç ve Yöntem: Çalışma 2017-2020 yılları arasında 4 yıllık retrospektif kesitsel çalışma olarak Göğüs Hastalıkları ve Göğüs Cerrahisi Eğitim ve Araştırma Hastanesinde yapıldı. Çalışma döneminde tanıları akciğer kanseri olan ve hastanede ölen hastalar çalışmaya alındı. Hastaların demografik verileri, yatış nedenleri, ek hastalıkları, hemogram, biyokimya değerleri, hastane içinde yer değişimleri, solunum destekleri (invaziv ve noninvaziv mekanik ventilasyon, oksijen) medikal tedavileri, ölüm yerleri, en çok dört ölüm nedenleri hastane mortalite verilerinden kayıt edildi. Veriler tanımlayıcı analiz ile özetlendi. Yıllar içindeki değişim kayıt edilen veriler ile karşılaştırıldı. Bulgular: Çalışma döneminde akciğer kanseri nedeni ile 15.552 hasta yatırıldı ve bu hastalardan ölen hasta sayısı 1896 (%12) olarak saptandı. Ölen 1896 hastanın 834’ü yani %44’ünün ilk yatış yeri palyatif bakımdı, bu hastalardan sadece 19’u tekrar yoğun bakıma sevk edildi. Palyatif servise yatışta yıllar içinde istatistiksel olarak anlamlı artış izlendi (p<0.001). Dış merkezlerden başvurunun seneler içinde istatistiksel olarak arttığı bulundu (p˂0.001). Hastalara uygulanan, non-invaziv mekanik ventilasyon, vazopressör tedavide yıllar içinde istatistiksel olarak anlamlı düşüş tespit edildi (p<0.001). Sonuç: Palyatif servislerin etkin olarak kullanıma başlanması yaşamın sonunda gereksiz agresif tedavilerin ve dolayısıyla maliyetin azalmasına ve yoğun bakım yataklarının etkin kullanımına da yol açacaktır. Ülke sağlık politikası belirlenmesine yardımcı olacak palyatif bakım farkındalığını arttırmaya yönelik çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

• Akciğer kanseri
• mortalite
• yoğun bakım
• palyatif bakım

Kaynakça

1. Miller KD, Siegel RL, Lin CC, Angela BM, Joan LK, Julia HR et al. Cancer treatment and survivor ship statistics, 2016. CA Cancer J Clin . 2016;66(4):271-89.
2. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2016. CA Cancer J Clin. 2016;66(1):7-30.
3. Zappa C, Shaker AM. Non-small cell lung cancer: current treatment and future advances. Transl Lung Cancer Res. 2016;5(3):288-300.
4. Richard BL. End-of-life care in patients with advanced lung cancer. Ther Adv Respir Dis. 2016;10(5)455–67.
5. Chih CL, Chung HH, Chin MC, Shyh RC, Chien MC, Wei LL et al.. Risk factors and mortality of adults with lung cancer admitted to the intensive care unit. J Thorac Dis.2018; 10(7):4118-126.
6. Derek CA, Amber EB, Walter TLZ, Lisa AW, R Scott W, Tim R et al. Use of intensive care at the end of life in the United States: An epidemiologic study. Crit Care Med. 2004;32(3):638–43.
7. Kress JP, Christenson J, Pohlman AS, Linkin DR, Hall JB. Out comes of critically ill cancer patients in a university hospital setting. Am J Respir Crit Care Med. 1999;160(6):1957-61.
8. Darmon M, Thiery G, Ciroldi M, Miranda S, Galicier L, Raffoux E et al. Intensive care in patients with newly diagnosed malignancies and a need for cancer chemotherapy. Crit Care Med . 2005;33(11):2488-93.

9. Soares M, Caruso P, Silva E, Teles CMM, Lobo SMA, Friedman G et al. Characteristics and out comes of patients with cancer requiring admission to intensive care units: a prospective multicenter study. Crit Care Med. 2010;38(1):9-15.
10. Turnbull A, Goldiner P, Silverman D, Howland W. The role of an intensive careunit in a cancer center. An analysis of 1035 critically ill patients treated for life-threatening complications editorial. Cancer 1976;37(1):82-4.
11. Larché J, Azoulay E, Fieux F, Mesnard L, Moreau D, Thiery G et al. Improved survival of critically ill cancer patients with septic shock. Intensive Care Med. 2003;29(10):1688-95.
12. Soares M, Darmon M, Salluh JIF, Ferreira CG, Thiery G, Schlemmer B et al.. Prognosis of lung cancer patients with life-threatening complications. Chest. 2007;131(3):840-46.
13. Ford DW, Koch KA, Ray DE, Selecky PA. Palliative and end of-life care in lung cancer: Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013;143(Suppl.5):e498-512.
14. Alexander M, Evans SM, Stirling RG, Wolf R, Manus MM, Solomon B et al.. The influence of comorbidity and the Simplified Comorbidity Score on overall survival in non-small cell lung cancer – a prospective cohort study. J Thorac Oncol. 2016;11(5):748–57.
15. Dreyer J, Bremer M, Henkenberens C. Comorbidity indexing for prediction of the clinical outcome after stereotactic body radiationt herapy in non-small cell lung cancer. Radiat Oncol. 2018;13(1):213.
16. Romano AM, Gade KE, Nıelsen G, Havard R, Harrıson JH, Barclay J et al. Early Palliative Care Reduces End-of-Life Intensive CareUnit (ICU)Use but Not ICU Course in Patients with Advanced Cancer. The Oncologist. 2017;22(3):318–23.
17. Ahluwalia SC, Tisnado DM, Walling AM, Sydney MD , Asch SM, Ettner SL et al. Association of Early Patient-Physician Care Planning Discussions and End-of-Life Care Intensity in Advanced Cancer . Journal Of Pallıatıve Medıcıne. 2015;18(10):834-41.
18. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA et al. Early Palliative Care for Patients with Metastatic Non–Small-Cell Lung Cancer. N Engl J Med. 2010;363(8):733-42.
19. Goldwasser F, Vinant P, Aubry R, Rochigneux P, Beaussant Y, Huillard O et al. Timing of Palliative Care Needs Reporting and Aggressiveness of Care Near the End of Life in Metastatic Lung Cancer: A National Registry-Based StudyCancer . 2018;124(14):3044-51.
20. World Health Organization (WHO). Accessed date: 22.12.2021: https://www.who.int/health-topics/palliative-care.