Palliative care among lung cancer patients with and without COPD: a population-based cohort study

Context — Lung cancer patients with chronic obstructive pulmonary disease (COPD) may have greater palliative care needs due to poor prognosis and symptom burden.

Objectives — We sought to compare the provision of timely palliative care and symptom burden by COPD status.

Methods — We performed a retrospective, population-based cohort study of individuals diagnosed with lung cancer in Ontario, Canada (2009 – 2019) using health administrative databases and cancer registries. The impact of COPD on the probability of receiving palliative care was determined accounting for dying as a competing event, overall and stratified by stage. The provision of palliative care for patients with severe symptoms (Edmonton Symptom Assessment Scale score ≥ 7), location of the first palliative care visit and symptom severity were compared by COPD status.

Results — 74,993 patients were included in the study (48% of patients had available symptom data). At the time of lung cancer diagnosis, 50% of patients had COPD. Stage I-III patients with COPD were more likely to receive palliative care (adjusted Hazard Ratio (HR)s: 1.05 to 1.31) with no difference for stage IV (1.02, 95% CI: 1.00 to 1.04). Despite having severe symptoms, very few patients with early-stage disease received palliative care (Stage I: COPD-23% vs. no COPD-18%, SMD=0.12). Most patients (84%) reported severe symptoms and COPD worsened symptom burden, especially among early-stage patients.

Conclusion — COPD impacts the receipt of palliative care and symptom burden for patients with early-stage lung cancer. Many patients with severe symptoms did not receive palliative care, suggesting unmet needs among this vulnerable population.