Palliative Care Consultation, Quality-of-Life Measurements, and Bereavement for End-of-Life Care in Patients With Lung Cancer*

Palliative Care Consultation, Quality-of-Life Measurements, and Bereavement for End-of-Life Care in Patients With Lung Cancer*
Objective: To develop clinical practice guidelines for application of palliative care consultation,
quality-of-life measurements, and appropriate bereavement activities for patients with lung
cancer.
Methods: To review the pertinent medical literature on palliative care consultation, quality-of-life measurements, and bereavement for patients with lung cancer, developing multidisciplinary
discussions with authorities in these areas, and evolving written guidelines for end-of-life care of
these patients.
Results: Palliative care consultation has developed into a new specialty with credentialing of
experts in this field based on extensive experience with patients in end-of-life circumstances
including those with lung cancer. Bereavement studies of the physical and emotional morbidity
of family members and caregivers before, during, and after the death of a cancer patient have
supported truthful communication, consideration of psychological problems, effective palliative
care, understanding of the patient’s spiritual and cultural background, and sufficient forewarning
of impending death.
Conclusion: Multidisciplinary investigations and experiences, with emphasis on consultation and
delivery of palliative care, timely use of quality-of-life measurements for morbidities of treatment
modalities and prognosis, and an understanding of the multifaceted complexities of the bereavement
process, have clarified additional responsibilities of the attending physician.
(CHEST 2007; 132:404S–422S)

RADIOTHERAPY OF METASTATIC SPINAL CORD COMPRESSION

Purpose: Owing to the aging of the population, the proportion of elderly patients receiving cancer treatment has
increased. This study investigated the results of radiotherapy (RT) for metastatic spinal cord compression
(MSCC) in the very elderly, because few data are available for these patients.
Methods and Materials: The data from 308 patients aged >75 years who received short-course (treatment time
1–5 days) or long-course RT (2–4 weeks) for MSCC were retrospectively analyzed for functional outcome, local
control, and survival. Furthermore, nine potential prognostic factors were investigated: gender, performance
status, interval from tumor diagnosis to MSCC, tumor type, number of involved vertebrae, other bone or visceral
metastases, ambulatory status, and speed at which motor deficits developed.
Results: Improvement of motor deficits occurred in 25% of patients, with no further progression of MSCC in an
additional 59%. The 1-year local control and survival rate was 92% and 43%, respectively. Improved functional
outcomes were associated with ambulatory status and slower developing motor deficits. Improved local control
resulted from long-course RT. Improved survival was associated with a longer interval from tumor diagnosis to
MSCC, tumor type (breast/prostate cancer, myeloma/lymphoma), lack of visceral or other bone metastases,
ambulatory status, and a slower development of motor deficits.
Conclusion: Short- and long-course RT are similarly effective in patients aged >75 years regarding functional
outcome and survival. Long-course RT provided better local control. Patients with better expected survival
should receive long-course RT and others short-course RT. The criteria for selection of an appropriate regimen
for MSCC in very elderly patients should be the same as for younger individuals. © 2007 Elsevier Inc.
Metastatic spinal cord compression, Very elderly patients, Treatment outcome.