The effects of palliative care towards survival rate of advanced lung cancer patients
Keywords:
lung cancer, palliative care, survival, emulation analysis, costAbstract
Objectives : To evaluate the effects of palliative care towards survival rate, numbers of day admitted in the intensive care unit, numbers of the emergency room visit, hospital costs and the defined daily dosage of analgesic use in advanced lung cancer patients.
Methods : A retrospective cohort study included advanced lung cancer patients who received palliative care program or standard care. They were hospitalized and died at Nakornping Hospital, Chiang Mai from June 1, 2016 to June 30, 2021. The follow-up time was stratified into two periods: 180 days and until death. The survival analysis was performed and presented by restricted mean survival time (RMST) and emulation analysis was used to adjust immortal bias, grace period at 90 days.
Results : The first period, 180 days follow up, contained 73 patients who received palliative care and 57 patients as a control group. The group of palliative care patients had a statistically significant lower mortality rate than the control group (Hazard ratio 0.66, 95% CI 0.46-0.96, p-value 0.023). However, the second period follow up until death contained 65 patients in each group. The weighted analysis, while eliminating immortal time bias, showed a statistically significant difference (Hazard ratio 0.48, 95% CI 0.30-0.75, p-value 0.002). Regarding original cohort group, the patients in palliative care had statistically significant higher RMST (Mean difference 12.23, 95% CI 3.28-21.18, p-value 0.008). Nonetheless, secondary outcomes showed no different between the palliative care group versus the control group throughout the treatment period until death in hospital costs for one year prior to death, numbers of day admitted in the intensive care unit, numbers of the emergency room visit and defined daily dose of morphine and fentanyl.
Conclusions : The advanced lung cancer patients who received palliative care had higher RMST than those received standard care. On the other hand, there were no differences of hospital costs for one year prior to death, numbers of day admitted in the intensive care unit, numbers of the emergency room visit and the defined daily dose of analgesic. Finally, this study provides alternative options for physicians, patients and families to plan their last golden period.
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