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Metastatic non-small cell lung cancer: a benchmark for quality end-of-life cancer care?

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Lung cancer is one of the most common fatal cancers in the world. In Australia, about 7500 patients die from lung cancer each year,1 and the median survival for those with metastatic non-small cell lung cancer (NSCLC) is 4–5 months.2 Despite improvements in survival, attention to symptoms and quality-of-life concerns form the mainstay of treatment for most patients.

Those with advanced lung cancer have a substantial symptom burden. Most patients experience appetite loss, fatigue, cough, dyspnoea and chest pain.3,4 In 2010, Temel and colleagues demonstrated that early introduction of palliative care integrated with standard oncological care for this population was associated with improved quality of life, reduced depression and less aggressive care at end of life.5 Following this, the American Society of Clinical Oncology released a provisional clinical opinion that patients with metastatic NSCLC “should be offered concurrent palliative care and standard oncologic care at initial diagnosis”, while national societies have endorsed timely palliative care referral.6,7

The aggressiveness of cancer care near the end of life has been proposed as…