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Lung cancer and end-of-life care: a systematic review and thematic synthesis of aggressive inpatient care
  1. Olivier Bylicki1,
  2. Morgane Didier2,
  3. Frederic Riviere1,
  4. Jacques Margery1,
  5. Frederic Grassin1 and
  6. Christos Chouaid2
  1. 1 Pneumologie, Hopital d'Instruction des Armees Percy, Clamart, France
  2. 2 Service de Pneumologie, Centre Hospitalier Intercommunal de Creteil, Creteil, France
  1. Correspondence to Dr Olivier Bylicki, Pneumologie, Hopital d'Instruction des Armees Percy, Clamart 92141, France; bylicki.olivier{at}


Objectives Despite recent advances in thoracic oncology, most patients with metastatic lung cancer die within months of diagnosis. Aggressiveness of their end-of-life (EOL) care has been the subject of numerous studies. This study was undertaken to evaluate the literature on aggressive inpatient EOL care for lung cancer and analyse the evolution of its aggressiveness over time.

Methods A systematic international literature search restricted to English-language publications used terms associated with aggressiveness of care, EOL and their synonyms. Two independent researchers screened for eligibility and extracted all data and another a random 10% sample of the abstracts. Electronic Medline and Embase databases were searched (2000–20 September 2018). EOL-care aggressiveness was defined as follows: 1) chemotherapy administered during the last 14 days of life (DOL) or new chemotherapy regimen during the last 30 DOL; 2) >2 emergency department visits; 3) >1 hospitalisation during the last 30 DOL; 4) ICU admission during the last 30 DOL and 5) palliative care started <3 days before death.

Results Among the 150 articles identified, 42 were retained for review: 1 clinical trial, 3 observational cohorts, 21 retrospective analyses and 17 administrative data-based studies. The percentage of patients subjected to aggressive therapy seems to have increased over time. Early management by palliative care teams seems to limit aggressive care.

Conclusions Our analysis indicated very frequent aggressive EOL care for patients with lung cancer, regardless of the definition used. The extent of that aggressiveness and its impact on healthcare costs warrant further studies.

  • lung cancer
  • aggressive care
  • end-of-life care
  • healthcare costs

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  • Contributors OB, CC and MD have read and analysed all the studies. All authors participated in the writing of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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