Palliative and end-of-life care in Asian and White patients with metastatic lung cancer.

Background: Data on palliative and end-of-life care for Asian patients with metastatic lung cancer in the United States are limited, though this is the leading cause of cancer death in this group. Early palliative care improved quality of life and survival in patients with metastatic lung cancer treated with chemotherapy. We examined palliative and end-of-life care patterns in Asian and White patients with metastatic lung cancer in the era of novel therapy.

Methods: Patients newly diagnosed with metastatic lung cancer from 2014 to 2019 were identified at our institution. Patient and disease characteristics and treatment information were compared between Asian and White patients by Mann-Whitney U test and Chi-square tests. Time-to-palliative care involvement was compared via log-rank test.

Results: Both Asian (N = 89) and White (N = 197) patients had low rates of palliative care involvement (38.2% vs 37.6%), with median time from diagnosis to first encounter exceeding a year. The most given frontline systemic therapy was targeted therapy and chemotherapy in Asian and White patients, respectively. Of 22 Asian (24.7%) and 74 White (37.6%) patients who died, Asian patients more often died in-hospital (68.2% vs 32.4%, P = .004), and did not have documented code status discussions with their outpatient oncologists (0% vs 24.3%, P = .010) within 6 months preceding death.

Conclusion: Early palliative care appears challenging to implement for Asian and White patients newly diagnosed with metastatic lung cancer in a real-world setting. A more patient-centered approach to integrating palliative and end-of-life care communications and interventions alongside precision oncology warrants further study.