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JTO Clin Res Rep. 2022 Jan 21;3(2):100283. doi: 10.1016/j.jtocrr.2022.100283. eCollection 2022 Feb.
INTRODUCTION: Medical assistance in dying (MAID) was legalized in Canada in 2016. Cancer accounts for 60% to 65% of MAID cases. Lung cancer, the most common cause of cancer death, is expected to account for a large number of MAID cases. Lung cancer treatment has advanced in recent years; however, the involvement of oncology specialists and the use of systemic therapy in patients who receive MAID are unknown.
METHODS: All lung cancer patients referred to the Champlain Regional MAID Program from June 17, 2016 to November 30, 2020 were reviewed. Basic demographics, diagnosis, referral, and treatment details were collected by retrospective review. The co-primary endpoints were the proportion of patients who saw a medical oncologist or who received systemic treatment.
RESULTS: During the study period, 255 cancer patients underwent MAID. Of these, 45 (17.6%) had lung cancer, constituting our final study population. Baseline characteristics: median age 72 years, 64% female, 85% past or current smoking history, 82% non-small cell, 4% small cell, and 13% clinical diagnosis without biopsy. Most patients (78%) were seen by a medical oncologist, although only 16 (36%) received systemic therapy for advanced disease. In the subpopulations of interest, 45% of patients with a programmed death ligand 1 greater than or equal to 50% received immunotherapy and 75% with an oncogenic driver mutation received targeted therapy. Twenty-six patients (58%) had a documented discussion with their oncologist regarding the transition to best supportive care.
CONCLUSIONS: Most lung cancer patients are evaluated by an oncology specialist prior to MA, although less than half have received systemic treatment. Among patients with more treatable forms of lung cancer, many patients are still undergoing MAID without having access to these treatment options or, in some cases, without being evaluated for them.