Patients with Metastatic Lung Cancer and Oncologists' Views on Achievement of Treatment Goals and Making the Right Treatment Decision: A Prospective Multicenter Study.

BACKGROUND: Previous studies have investigated patients' treatment goals before starting a treatment for metastatic lung cancer. Data on the evaluation of treatment goals are lacking. AIM: To determine if patients with metastatic lung cancer and their oncologists perceive the treatment goals they defined at the start of systemic treatment as achieved after treatment and if in hindsight they believe it was the right decision to start systemic therapy. DESIGN AND PARTICIPANTS: A prospective multicenter study in 6 hospitals across the Netherlands between 2016 and 2018. Following systemic treatment, 146 patients with metastatic lung cancer and 23 oncologists completed a questionnaire on the achievement of their treatment goals and whether they made the right treatment decision. Additional interviews with 15 patients and 5 oncologists were conducted. RESULTS: According to patients and oncologists, treatment goals were achieved in 30% and 37% for 'quality of life,' 49% and 41% for 'life prolongation,' 26% and 44% for 'decrease in tumor size,' and 44% for 'cure', respectively. Most patients and oncologists, in hindsight, felt they had made the right decision to start treatment even if they had not achieved their goals (72% and 93%). This was related to the feeling that they had to do 'something.' CONCLUSIONS: Before deciding on treatment, the treatment options, including their benefits and side effects, and the goals patients have should be discussed. It is key that these discussions include not only systemic treatment but also palliative care as effective options for doing 'something.'

Chemotherapy and Tyrosine Kinase Inhibitors in the last month of life in patients with metastatic lung cancer: A patient file study in the Netherlands.

OBJECTIVE: Chemotherapy in the last month of life for patients with metastatic lung cancer is often considered as aggressive end-of-life care. Targeted therapy with Tyrosine Kinase Inhibitors (TKIs) is a relatively new treatment of which not much is known yet about use in the last month of life. We examined what percentage of patients received chemotherapy or TKIs in the last month of life in the Netherlands. METHODS: Patient files were drawn from 10 hospitals across the Netherlands. Patients had to meet the following eligibility criteria: metastatic lung cancer; died between June 1, 2013 and July 31, 2015. RESULTS: From the included 1,322 patients, 39% received no treatment for metastatic lung cancer, 52% received chemotherapy and 9% received TKIs. A total of 232 patients (18%) received treatment in the last month of life (11% chemotherapy, 7% TKIs). From the patients who received chemotherapy, 145 (21%) received this in the last month of life and 79 (11%) started this treatment in the last month of life. TKIs were given and started more often in the last month of life: from the patients who received TKIs, 87 (72%) received this treatment in the last month of life and 15 (12%) started this treatment in the last month of life. CONCLUSION: A substantial percentage of patient received and even started chemotherapy or TKIs in the last month of life. For chemotherapy, this might be seen as aggressive care. TKIs are said to have less side effects, do not lead to many hospital visits and due to the rapid response, are considered good palliation. However, it is not known, yet possible that, when patients still receiving treatment until shortly before death, this might influence preparing for death in a negative way.

Is In-Hospital Mortality Higher in Patients With Metastatic Lung Cancer Who Received Treatment in the Last Month of Life? A Retrospective Cohort Study.

CONTEXT: Metastatic lung cancer is an incurable disease that results in a high burden of symptoms, a poor quality of life, and an expected prognosis of less than one year after diagnosis. Treatment shortly before death may result in potential burdensome and inappropriate hospital admissions and hospital deaths. Dying at home is, at a population level, considered a quality for good end-of-life care. OBJECTIVES: We examined what percentage of patients with metastatic lung cancer died inside the hospital and if hospital death, or other characteristics of the patient, oncologist or health care, were associated with treatment in the last month of life. METHODS: This retrospective cohort study evaluated the medical records of 1322 patients with metastatic lung cancer who received care at one of 10 hospitals across The Netherlands and died between 1/6/2013 and 31/7/2015. Demographic and clinical characteristics were obtained from the medical records. RESULTS: In total, 18% of the patients died during a hospital admission. This percentage was higher for patients who received chemotherapy (42%) or targeted therapy with tyrosine kinase inhibitors (25%) in the last month of life. Patients younger than 60 years of age, patients who received chemotherapy in the last month of life, and patients in whom tyrosine kinase inhibitors were started in the last month of life were more likely to die inside the hospital. CONCLUSION: In The Netherlands, fewer than one in five patients with metastatic lung cancer died in the hospital and in-hospital death was associated with the relatively late use of chemotherapy or targeted therapy. Careful selection of patients for disease-modifying therapy might enhance the opportunity for patients to die at their preferred place.