Poster: ECR 2019 / C-2656 / Pulmonary effects of illicit drug use- A Pictorial Review. by: S. Prasher 1, D. Penha2, E. Pinto1, D. Wat1, S. Pilsworth 1, M. Ledson1, B. Hochhegger3, E. Marchiori4, K. L. Irion5; 1Liverpool/UK, 2Lisbon/PT, 3Porto Alegre/BR, 4Rio de Janeiro/BR, 5Manchester/UK
The End of Life Care Strategy advocates the identification and support of patients approaching the end of their lives, and to aid this, social care benefits can be awarded to those with a life expectancy <6 months by completion of a DS1500 form. Many lung cancer patients fall into this category: we wished to look at the use of this enhanced support mechanism in our busy lung cancer unit.
Method
We looked at the use of DS1500 in the initial period for 100 consecutive outpatients with lung cancer diagnosed through our rapid access clinic in 2007 (mean age 73 years [SD 8], mean PS=2 [IQR 2], 47 females), comparing its use with survival and histological tumour type. Mortality data were obtained from the national registry.
Results
Twenty two had a DS1500 completed (median 26 days [20] from presentation): there was no difference in age, sex or PS between these and the remainder. Of the 75 with a tissue diagnosis, only those with non-small cell cancer were more likely to receive a form (16/22 vs 30/78 χ2=8.1, p=0.004). Only three patients with a clinical diagnosis and three with small cell received forms (both p=NS). Overall median survival was 216 days [IQR 405], with 57 alive at 6 months and 33 at 1-year. Median survival was 193 [268] days for those with DS1500 compared with 224 [458] in the remainder (p=NS), and 31 (57%) of those who died within 6 months did not benefit from early DS1500 status.
Conclusion
While the DS1500 use was appropriate, the number identified represented less than a half of those who died within 6 months of presentation, and those with the poorest prognosis (small cell type or a clinical diagnosis) did not benefit the most. It seems we are missing an opportunity to support this unfortunate group of patients at the time of their greatest need.
Background: Colonisation with Burkholderia cepacia is a poor prognostic indicator in subjects with cystic fibrosis (CF), but outcome prediction is impossible since patients are colonised by different strains with differing pathogenicity. The clinical course of a large cohort of CF patients colonised with UK epidemic (ET12) B cepacia was followed for 5 years and compared with that of the remaining patients in the clinic. Methods: Pulmonary function, nutritional state, and lung pathogen colonisation were recorded for 5 years before December 1997 or death for all 107 patients who had attended the Liverpool adult CF clinic since 1993. For each patient a time line from study entry to date of death or 1997 was constructed. In 1993 potential risk factors including age and sex were subjected to Cox proportional hazards analysis using the end point of mortality as the outcome variable. The analysis was supplemented by time varying covariables that described the change in FEV1, BMI, and colonisation status across time, and the excess risk associated with B cepacia colonisation was calculated. Subsequently, in those patients who died between 1993 and 1997, predictive factors for death were compared within groups using complete 5 year data. Results: Thirty seven patients had been colonised by epidemic B cepacia and these patients had four times the mortality of the remainder (p<0.01). In 1993 univariate predictors of mortality were age (alive 19.6 (0.64) v dead 23.8 (1.44); p<0.005) and baseline FEV1 (alive 68.6 (2.5)% predicted v dead 43.2 (4.8)%; p<0.001) with a trend for BMI (p=0.07). However, following time varying covariate Cox proportional hazards analysis, only lower FEV1 (hazards ratio 1.1, 95% confidence limits 1.06 to 1.14; p<0.001) and colonisation with B cepacia (hazards ratio 7.92, confidence limits 2.65 to 23.69; p<0.001) were identified as significant factors for death. Surviving B cepacia patients had similar initial lung function to the remaining surviving patients but had an accelerated loss of lung function over the study period (colonised –1.9% predicted per year v non-colonised –0.3% predicted per year; p<0.05). Deceased patients colonised with B cepacia had better spirometric results than the remaining deceased patients 5 years before death (p<0.05) but lost lung function at a greater rate than non-colonised patients (colonised –6.2% predicted per year v non-colonised –1.9% predicted per year; p<0.05). Conclusions: This study confirms the excess mortality associated with epidemic B cepacia colonisation and shows that those with poor spirometric values are at the greatest risk.
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