Palliative care for interstitial lung disease more difficult than for lung cancer

Providing palliative care (PC) for patients with interstitial lung disease (ILD) appears more challenging than for those with lung cancer (LC), according to a study. Pulmonary specialists have also cited some ILD-specific barriers in PC.

In this study, the investigators conducted a nationwide, self-administered questionnaire, which was sent by mail to 3,423 pulmonary specialists certified by the Japanese Respiratory Society. The questionnaire assessed the current practices of PC for ILD, end-of-life communication, referral to a PC team, barriers to PC for ILD, and comparison of PC between ILD and LC.

Among the identified specialists, 1,332 (38.9 percent) completed the questionnaire, and data from 1,023 participants who had cared for ILD patients in the last year were included in the analysis.

Majority of the participants reported that ILD patients often or always complained of cough and dyspnoea, but only one in four specialists (25 percent) referred their patients to a PC team. The timing of end-of-life communication tended to be later when compared with the physician-perceived ideal timing.

Notably, pulmonary specialists reported having significantly greater difficulty in symptomatic relief and decision-making in PC for ILD patients than in those with LC. In addition, prescription of opioids for dyspnoea was not as common for ILD than for LC.

The investigators then identified ILD-specific barriers in PC, which included the inability to predict prognosis, lack of established treatments for dyspnoea, shortage of psychological and social support, and difficulty for patients/families to accept the disease’s poor prognosis.

“Multifaceted clinical studies are needed to develop optimal PC for ILD,” the investigators said.