Abstract
BackgroundMalignant and non-malignant respiratory diseases account for >4.6 million deaths annually worldwide. Despite similar symptom burdens, serious inequities in access to palliative care persists for people with non-malignant respiratory diseases.AimTo compare functional decline and symptom distress in advanced malignant and non-malignant lung diseases using consecutive, routinely collected, point-of-care national data.Setting/participantsThe Australian national Palliative Care Outcomes Collaboration collects functional status (Australia-modified Karnofsky Performance Status (AKPS)) and symptom distress (patient-reported 0–10 numerical rating scale) in inpatient and community settings. Five years of data used Joinpoint and weighted scatterplot smoothing.ResultsIn lung cancers (89 904 observations; 18 586 patients) and non-malignant end-stage respiratory diseases (14 827 observations; 4279 patients), age at death was significantly lower in people with lung cancer (73 years; IQR 65–81) than non-malignant end-stage respiratory diseases (81 years; IQR 73–87 years; p<0.001). Four months before death, median AKPS was 40 in lung cancers and 30 in non-malignant end-stage respiratory diseases (p<0.001). Functional decline was similar in the two groups and accelerated in the last month of life. People with non-malignant diseases accessed palliative care later.Pain-related distress was greater with cancer and breathing-related distress with non-malignant disease. Breathing-related distress increased towards death in malignant, but decreased in non-malignant disease. Distress from fatigue and poor sleep were similar for both.ConclusionsIn this large dataset unlike previous datasets, the pattern of functional decline was similar as was overall symptom burden. Timely access to palliative care should be based on needs not diagnoses.
Funder
Department of Health and Ageing, Australian Government
Subject
Pulmonary and Respiratory Medicine
Reference39 articles.
1. The global burden of cancer 2013;Fitzmaurice;JAMA Oncol,2015
2. Global cancer statistics, 2012;Torre;CA Cancer J Clin,2015
3. World Health Organization . Chronic obstructive pulmonary disease (COPD). fact sheet, 2017. Available: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(copd)#:~:text=The%20Global%20Burden%20of%20Disease,in%20low%20and%20middleincome%20countries [Accessed 11 Nov 2020].
4. Understanding breathlessness: cross-sectional comparison of symptom burden and palliative care needs in chronic obstructive pulmonary disease and cancer;Bausewein;J Palliat Med,2010
5. A comparison of the palliative care needs of patients dying from chronic respiratory diseases and lung cancer;Edmonds;Palliat Med,2001
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