Comparative Analysis of the Attitudes toward Palliative Care between Medical Oncologists and Pulmonologists

Abstract

Objective In Japan, both medical oncologists and pulmonologists treat lung cancer patients; however, the difference in their attitude toward palliative care referral is unknown. Thus, we retrospectively investigated the difference in attitudes toward palliative care referral between medical oncologists and pulmonologists in Japan. Methods We retrospectively reviewed the charts of patients with thoracic malignancy who died at Shimane University Hospital between June 2011 and October 2015. We compared the patients' demographics and medical history according to their doctor's specialty (i.e., medical oncologist or pulmonologist). Results We identified 182 patients, among whom 90 were treated by medical oncologists and 56 by pulmonologists at the outpatient clinic. Thirty-six patients did not undergo outpatient clinic treatment. Out of 59 patients, 22 (37.3%) referred by medical oncologists, and 7 out of 36 patients (19.4%) referred by pulmonologists, were referred to palliative care specialists in the outpatient setting (p=0.107, Fisher's exact test). The median survival time after admission to PCU was 21 (95% CI: 13-32) and 9 (95% CI: 5-15) days among the patients treated by medical oncologists and pulmonologists, respectively (p=0.128). Conclusion Medical oncologists are more likely to refer their patients to palliative care in the outpatient setting, thus enabling patients to receive longer end of life care in the PCU. Bridging the research gap regarding differences between the physicians' attitudes toward palliative care referral may lead to patients receiving more quality palliative care.

Keywords: chemotherapy; lung cancer; medical oncologist; palliative care; pulmonologist.

Figure 1.

Survival after the last chemotherapy treatment. The figure shows Kaplan-Meier estimates of overall survival after the last chemotherapy treatment. In the 66 patients who were treated by medical oncologists, the median overall survival was 76.0 days (black). In the 40 patients who were treated by pulmonologists, the median overall survival was 78.5 days (red).

Figure 2.

Timing of referral to palliative care specialists. Among the 90 patients who were treated by medical oncologists, 37 (41%) and 22 (25%) patients were referred to palliative care specialists in the inpatient setting and the outpatient setting, respectively. Thirty-one (34%) were not referred. Among the 56 patients who were treated by pulmonologists, 29 (52%) and 7 (12%) patients were referred to palliative care specialists in the inpatient setting and the outpatient setting, respectively. Twenty (36%) were not referred.

Figure 3.

Patients' survival after palliative care unit admission. The figure shows Kaplan-Meier estimates of overall survival after PCU admission. a) In the 61 patients who were referred to palliative care specialists in the inpatient setting, the median overall survival was 10.0 days (black). In the 28 patients who were referred in the outpatient setting, the median overall survival was 20.5 days (red). b) In the 48 patients who were treated by medical oncologists, the median overall survival was 21 days. In the 33 patients who were treated by pulmonologists, the median overall survival was 9.0 days.