• We are sorry, but NCBI web applications do not support your browser and may not function properly. More information
Logo of thoraxThoraxVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Thorax. Dec 2000; 55(12): 1000–1006.
PMCID: PMC1745647

How well do we care for patients with end stage chronic obstructive pulmonary disease (COPD)? A comparison of palliative care and quality of life in COPD and lung cancer

Abstract

BACKGROUND—Patients with severe chronic obstructive pulmonary disease (COPD) have a poor quality of life and limited life expectancy. This study examined whether these patients were relatively disadvantaged in terms of medical and social care compared with a group with inoperable lung cancer.
METHODS—An open two group comparison was made of 50 patients with severe COPD (forced expiratory volume in one second (FEV1) <0.75 l and at least one admission for hypercapnic respiratory failure) and 50 patients with unresectable non-small cell lung cancer (NSCLC). A multi-method design was used involving standardised quality of life tools, semi-structured interviews, and review of documentation.
RESULTS—The patients with COPD had significantly worse activities of daily living and physical, social, and emotional functioning than the patients with NSCLC (p<0.05). The Hospital Anxiety and Depression Scale (HADS) scores suggested that 90% of patients with COPD suffered clinically relevant anxiety or depression compared with 52% of patients with NSCLC. Patients were generally satisfied with the medical care received, but only 4% in each group were formally assessed or treated for mental health problems. With regard to social support, the main difference between the groups was that, while 30% of patients with NSCLC received help from specialist palliative care services, none of the patients with COPD had access to a similar system of specialist care. Finally, patients in both groups reported a lack of information from professionals regarding diagnosis, prognosis and social support, although patients' information needs were disparate and often conflicting.
CONCLUSION—This study suggests that patients with end stage COPD have significantly impaired quality of life and emotional well being which may not be as well met as those of patients with lung cancer, nor do they receive holistic care appropriate to their needs.

Full Text

The Full Text of this article is available as a PDF (148K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • McSweeny AJ, Grant I, Heaton RK, Adams KM, Timms RM. Life quality of patients with chronic obstructive pulmonary disease. Arch Intern Med. 1982 Mar;142(3):473–478. [PubMed]
  • Eve A, Smith AM, Tebbit P. Hospice and palliative care in the UK 1994-5, including a summary of trends 1990-5. Palliat Med. 1997 Jan;11(1):31–43. [PubMed]
  • McCarthy M, Lay M, Addington-Hall J. Dying from heart disease. J R Coll Physicians Lond. 1996 Jul-Aug;30(4):325–328. [PubMed]
  • Shee CD. Palliation in chronic respiratory disease. Palliat Med. 1995 Jan;9(1):3–12. [PubMed]
  • Jones PW, Quirk FH, Baveystock CM, Littlejohns P. A self-complete measure of health status for chronic airflow limitation. The St. George's Respiratory Questionnaire. Am Rev Respir Dis. 1992 Jun;145(6):1321–1327. [PubMed]
  • Bergman B, Aaronson NK, Ahmedzai S, Kaasa S, Sullivan M. The EORTC QLQ-LC13: a modular supplement to the EORTC Core Quality of Life Questionnaire (QLQ-C30) for use in lung cancer clinical trials. EORTC Study Group on Quality of Life. Eur J Cancer. 1994;30A(5):635–642. [PubMed]
  • Ware JE, Jr, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992 Jun;30(6):473–483. [PubMed]
  • Yohannes AM, Roomi J, Connolly MJ. Elderly people at home disabled by chronic obstructive pulmonary disease. Age Ageing. 1998 Jul;27(4):523–525. [PubMed]
  • Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361–370. [PubMed]
  • Kurtz ME, Kurtz JC, Stommel M, Given CW, Given B. Loss of physical functioning among geriatric cancer patients: relationships to cancer site, treatment, comorbidity and age. Eur J Cancer. 1997 Dec;33(14):2352–2358. [PubMed]
  • Viramontes JL, O'Brien B. Relationship between symptoms and health-related quality of life in chronic lung disease. J Gen Intern Med. 1994 Jan;9(1):46–48. [PubMed]
  • Brazier JE, Harper R, Jones NM, O'Cathain A, Thomas KJ, Usherwood T, Westlake L. Validating the SF-36 health survey questionnaire: new outcome measure for primary care. BMJ. 1992 Jul 18;305(6846):160–164. [PMC free article] [PubMed]
  • Okubadejo AA, O'Shea L, Jones PW, Wedzicha JA. Home assessment of activities of daily living in patients with severe chronic obstructive pulmonary disease on long-term oxygen therapy. Eur Respir J. 1997 Jul;10(7):1572–1575. [PubMed]
  • Clark A, Fallowfield LJ. Quality of life measurements in patients with malignant disease: a review. J R Soc Med. 1986 Mar;79(3):165–169. [PMC free article] [PubMed]
  • Meecham Jones DJ, Paul EA, Jones PW, Wedzicha JA. Nasal pressure support ventilation plus oxygen compared with oxygen therapy alone in hypercapnic COPD. Am J Respir Crit Care Med. 1995 Aug;152(2):538–544. [PubMed]
  • Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, Filiberti A, Flechtner H, Fleishman SB, de Haes JC, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Inst. 1993 Mar 3;85(5):365–376. [PubMed]
  • van Ede L, Yzermans CJ, Brouwer HJ. Prevalence of depression in patients with chronic obstructive pulmonary disease: a systematic review. Thorax. 1999 Aug;54(8):688–692. [PMC free article] [PubMed]
  • Hardman A, Maguire P, Crowther D. The recognition of psychiatric morbidity on a medical oncology ward. J Psychosom Res. 1989;33(2):235–239. [PubMed]
  • Faulkner A. ABC of palliative care. Communication with patients, families, and other professionals. BMJ. 1998 Jan 10;316(7125):130–132. [PMC free article] [PubMed]
  • Cockcroft A, Bagnall P, Heslop A, Andersson N, Heaton R, Batstone J, Allen J, Spencer P, Guz A. Controlled trial of respiratory health worker visiting patients with chronic respiratory disability. Br Med J (Clin Res Ed) 1987 Jan 24;294(6566):225–228. [PMC free article] [PubMed]

Articles from Thorax are provided here courtesy of BMJ Group

Formats:

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...

Links

  • Cited in Books
    Cited in Books
    PubMed Central articles cited in books
  • MedGen
    MedGen
    Related information in MedGen
  • PubMed
    PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...