End-of-life antimicrobial usage in lung cancer: current perpectives and clinical practice

Infections frequently trigger or worsen disabling symptoms at the end-of-life. Clinical judgement prevails to determine antimicrobial usage, in the absence of best practice guidelines. Particularly for lung cancer, neoplasms can facilitate or mimic respiratory infections. We aimed to describe antimicrobial prescription habits at the end of life for lung cancer patients and identify the factors conditioning clinical decisions. We surveyed medical specialities frequently involved in end-of-life decisions for lung cancer patients by an online questionnaire. IBM SPSS was used to perform statistical analysis. We collected 110 answers from medical doctors, mainly Pulmonologists (n=59, 53,6%) and women (n=81, 73,6%). A proportion of 17,3% received post-graduate education in palliative care, although only 2,7% worked at palliative care centres. The most frequent reasons to suspect infection and initiate antimicrobials were fever (n=99, 90,00%), the onset of purulent sputum (n=100, 90,90%), radiologic changes (n=81, 73,60%) and high acute-phase parameters (n=82, 74,55%). Post-graduate formation in palliative care was associated with lower tendency to perform invasive procedures (sample collection, p=0,037 and IV antimicrobials, p