Health care utilization of patients with chronic obstructive pulmonary disease and lung cancer in the last 12 months of life

Background: Previous studies have documented similar levels of end-of-life symptom burden for lung cancer and chronic obstructive pulmonary disease (COPD) patients, yet there has been little comparison of health care utilization during this period. This study contrasts health care utilization by people with COPD and those with lung cancer in the 12 months prior to death. Methods: We performed a retrospective cohort study of 1098 patients who died in 2004 with a cause of death recorded as COPD or lung cancer using administrative health data. Our outcomes of interest included acute, tong-term and home care service utilization. Results: The study population was 42% female with a mean age of 77 years (S.D. = 11). In the last 12 months of life, decedents with COPD were more likely to be institutionalized in a LTC setting (41% vs. 12.5%, p<0.05) and to receive tong-term home care (26% vs. 9.7%, p<0.05), but were much less likely to receive palliative care in hospital (47.6% vs. 5.1%, p<0.001) or at home (37.4% vs. 2.8%, p<0.05) than people with lung cancer. In contrast decedents with lung cancer made greater use of acute care services than those with COPD in that they were more likely to be hospitalized (94.2% vs. 80.4%, p<0.05) and had longer median LOS (7.0 vs. 5.7 days, p<0.05) than those with COPD. No differences in the number of out-patient physician visits were noted. Conclusions: Patterns of end-of-life health care utilization differ significantly between people with lung cancer and those with COPD. Further research is needed to establish need and determine gaps in services to better address the needs of people dying with COPD. (C) 2008 Elsevier Ltd. All rights reserved.