J.LESTARI1, J.A.ABISHEGANADEN1, H.Y.NEO1, G.T.CHAI1
Tan Tock Seng Hospital1
Advanced interstitial lung disease (ILD) is associated with poor quality of life and high symptom burden. We examined the impact of outpatient palliative care referrals in end-of-life care of ILD patients.
Single centre retrospective study of ILD patients who passed away between February 2016 to March 2021. Patients who received outpatient palliative care services (palliative group) were compared against those who were not (usual care group).
There were 63 decedents, 26 (41%) in the palliative group and 37 (59%) in the usual care group. Median time to outpatient palliative care referral was 8.6 (IQR 0.3-21.2) months. There was no difference in median age, gender distribution, duration of symptoms and ILD diagnoses in both groups. The palliative group had higher median mMRC dyspnoea score (3.5 [IQR2-4] vs 2 [IQR2-4]), p=0.039) and more patients on oxygen supplementation (70% vs 30%, p<0.001). There was no difference in median number of hospitalizations or length of stay in the last 6 months of life in both groups but more patients in the usual care group underwent mechanical ventilation (n=5 [10%] vs 0). More patients in the palliative group used opioids (96% vs 27%, p<0.001). Intriguingly, the palliative group survived longer compared to the usual care group (24.2 months [IQR10.9-38.7] vs 11.4 months [IQR3.6-18.3], p= 0.017).
Patients in the palliative group have higher symptom burden but no increase in healthcare utilisation in their last 6 months of life. Their longer associated survival should be examined in future studies.