In the terminal stage of lung cancer, 99% of the patients had at least one or more symptoms of pain, dyspnea, nausea, cough, hemoptysis, and psychological and neurologic difficulties. The most frequent symptoms were pain, psychological manifestations, and/or dyspnea. One fourth of patients had nausea, cough, and/or neurologic symptoms, and only one tenth displayed hemoptysis. Two thirds of the terminal lung cancer patients had three or more symptoms.
The strength of this study is that 98% of all lung cancer patients in a defined hospital area were included and 89% had a histologic confirmation, which is higher than previous studies. The cohort of patients was followed up from 5 to 11 years, and we were able to obtain information concerning the terminal stage of lung cancer in 98% of those who died.
There were 271 incident lung cancer patients from 1990 to 1997. Eighteen patients (6.6%) were alive by December 1, 2003. The diagnosis was confirmed by histology in 218 patients (89%). Information on symptoms and treatment in the terminal 8 weeks were collected from 247 of the 253 patients (98%) who died within this period of surveillance. One patient died abroad, and the records of five patients were not available. Only 53 of the 247 deaths (22%) were in women. The distribution of age, stage, performance status, and histology at the time of initial diagnosis (Table 1) did not differ between genders (p > 0.05). Of 56 patients with small cell lung carcinoma (SCLC) 27 patients had localized disease corresponding to stage I-III, and 29 patients had extensive disease with metastasis corresponding to stage IV. The average age was 68.5 years (SD, 10.1 years; range, 38 to 89 years). Initial antineoplastic treatment (surgery, radiotherapy, and/or chemotherapy) was administered to 60% of the patients. Lung cancer was the underlying cause of death in 227 patients and was contributory to death in 15 of the remaining 20 patients. The average time from beginning of symptoms to diagnosis was 89 days.
The mortality rate of lung cancer is high, and there has been little improvement in the long-term survival over the last 40 years. In addition, information is lacking whether sex, age, initial stage and performance status, and histology may predict the presence of serious symptoms in the terminal stage. In previous community studies of patients dying from lung cancer, 78% displayed dyspnea and 85% had pain in the final year of life, while depression was observed in 33% of patients with lung cancer referred to palliative treatments centers. In the first study, the participation rate was only 69%, while the latter was comprised of patients from three lung cancer trials with very different inclusion criteria, Comparison of these studies is difficult due to these different inclusion criteria and also to information gathered at various points during the course of the disease. Quality of life measurements give incomplete information at the end stage because many patients are unable to fill out the questionnaires. Therefore, information is not available concerning the incidence and prevalence of major symptoms in the terminal care of lung cancer patients from a population-based study.