Aims
Palliative care engagement in a multidisciplinary care context are key recommendations for the management of lung cancer. This study aimed to investigate the relationship between case discussion at the Alfred Health Lung Multidisciplinary Meeting (MDM), referral to palliative care, and end-of-life-care.
Methods
This study included all Alfred Health patients diagnosed with primary lung cancer in 2017. Relevant data were extracted from the Victorian Lung Cancer Registry (VLCR) and Alfred Health electronic medical records. Results were analysed with chi-squared tests to compare differences between groups.
Results
145 patients were studied, with median age 70 years. Most patients (76%) were discussed at MDM. Likelihood of MDM discussion increased with better performance status (ECOG 0 92.3% vs. ECOG 4 33%, p = 0.0499) and localised disease (localised 95.5% vs. metastatic 72.0%, p<0.001). 37% of patients were referred to palliative care. Likelihood of palliative care referral increased with metastatic disease (16.7% localised vs. 64% metastatic, p <0.001), poorer performance status (ECOG 0 17.9%, vs. ECOG 4 100%, p<0.001) and smoking (smokers 39.4% vs. non-smokers 13.6%, p=0.046). Patients discussed at MDM were less likely to be referred to palliative care (31.8% vs. 52.9%, p = 0.026). 58% of the 62 patients who died during the study period were referred to palliative care. Referral to palliative care was not associated with reduction in chemotherapy, hospitalisation, emergency visits or intensive care admission in last 30 days of life, nor did it affect place of death.
Conclusion
Most Alfred Health lung cancer patients are discussed at the Lung MDM, but a minority are referred to palliative care. Those discussed at MDM were less likely to be referred to palliative care. Palliative care referral did not appear to reduce rates of hospital treatment at end-of-life. Further research is needed to better understand these findings and improve patient outcomes.