Development in end-of-life care in lung cancer in Germany between 2009 and 2013

Objectives Germany introduced new procedural codes for specialized palliative care for hospitals in 2012 and outpatient physicians in 2013 enhancing reimbursement for corresponding services. Our study aimed to discover resulting changes in End-of-life care in patients with lung cancer.

Materials and Methods We compared claims data of AOK Statutory Health Insurance Fund between a cohort of lung cancer patients diagnosed in 2009 (n = 12,929) and 2013 (n = 14,262) who died during three years post diagnosis. We used information on hospitalizations and outpatient doctor visits, as well as in- and outpatient procedural codes (OPS, GONR) and ATC codes. To describe end-of-life care, we compared receipt of palliative care, inpatient death, unplanned hospitalizations, hospital days, outpatient doctor, general practitioner (GP) and home visits, therapy with antidepressants, pain relief medication, and chemotherapy, as well as therapeutic puncturing in the last 30 and 14 days of life, using logistic regression. We adjusted all models for sex, nursing home residency, care dependency, comorbidities and rural or urban residence.

Results The proportion of patients receiving their first palliative care treatment at least 30 days prior to death increased from 16.2% in 2009 to 43.5% in 2013 (OR = 3.98, C I= [3.76, 4.22]). The likelihood of inpatient death was lower in 2013 compared to 2009 (OR = 0.84, CI = [0.80, 0.88]), as was the likelihood to have more than one hospital admission (OR = 0.89, CI = [0.84, 0.93]), and the likelihood of spending more than 14 days in the hospital (OR = 0.89, CI = [0.84, 0.93]), during the last 30 days of life. However, the likelihood of an unplanned hospitalization increased (OR = 1.13, CI = [1.04, 1.22]). Therapy with antidepressants in the last 30 days, and chemotherapy in the last 14 days of life did not change significantly, but receipt of pain relief medication increased (OR = 1.08, CI = [1.03, 1.14]). The likelihood of receiving a therapeutic puncture did not change.

Conclusion End-of-life care changed after the introduction of the new codes concerning specialized palliative care. Aspects reflecting less aggressive end-of-life of care have improved, especially concerning inpatient death and hospitalizations in the last weeks of life.