A comparison of the palliative care needs of patients dying from chronic respiratory diseases and lung cancer

This paper reports on data from the Regional Study of Care for the Dying, c onducted in 1990, and compares symptoms, care and service utilization for p atients with chronic lung diseases (CLD) and lung cancer (LC) in the final 12 months of life. Post-bereavement structured interviews were conducted wi th informal carers of 449 LC patients and 87 CLD patients. The LC patients were significantly young er than those with CLD (P = 0.001) and these respo ndents were more likely to have been a spouse (P = 0.034). No differences w ere found in the mean number of symptoms reported by the two groups in the final year or week of life, although the CLD patients were more likely to h ave experienced these symptoms for longer. Significantly more patients with CLD than LC experienced breathlessness in the final year (94% CLD vs 78% L C, P < 0.001) and final week (91% CLD vs 69% LC, P < 0.001) of life. Signif icantly more LC patients were reported to have experienced anorexia (76% LC vs 67% CLD, P = 0.06) and constipation (59% LC vs 44% CLD, p = 0.01) in th e final year of life. There were no differences in general practitioner use , but LC patients were reported to have received more help from district nu rses (52% LC vs 39% CLD, P = 0.025) and from a palliative care nurse (29% L C vs 0% CLD. P < 0.001). More CLD patients were reported to have received h elp from social services (29% CLD vs 18% LC. P = 0.037). LC patients were r eported to be more likely to have known they might die (76% LC vs 62% CLD, P = 0.003) and to have been told this by a hospital doctor (30% LC vs 8% CL D, P = 0.001). Among those that knew, LC patients were told earlier prior t o death than CLD patients. This study suggests that patients with CLD at th e end of life have physical and psychosocial needs at least as severe as pa tients with lung cancer.