Patterns of treatment prior to death among those with lung cancer: A national study in a universal healthcare context

The intensity of cancer treatment delivered to patients in their final days of life will likely vary depending on many factors. This study examines interventional procedures, radiation therapy and systemic therapy receipt in the 30 days prior to death in a national cohort of lung cancer patients who were diagnosed and died between 2012-2019 (n = 14,822), and explores the extent to which this receipt differs depending on multiple sociodemographic and cancer-related factors. We found that the most common form of treatment was palliative radiation therapy (age std. proportion: 11 %), followed by palliative interventional procedures (6 %) and systemic therapy (5 %). Curative interventional procedures and curative radiation therapy were extremely rare prior to death (<1%). Almost all palliative interventional procedures were drainage or pleurodesis procedures (99 %). Receipt of palliative radiation therapy and systemic therapy (but not interventional procedures) reduced with increasing age, and also with increasing comorbidity. Palliative interventional procedures and palliative radiation therapy were more likely among those with non-small cell lung cancers than other forms, while those with small-cell lung cancers were much more likely to receive systemic therapy toward the end of life. Our findings tentatively indicate that clinical services in New Zealand are appropriately reducing futile treatment toward the end of life, although more work is needed to explore this with more granularity than possible in the current study.