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a Medical Chest Unit,
Castle Hill Hospital, Cottingham HU16 5JQ, East Yorkshire, b Faculty of Health, University of Hull, Hull,
East Yorkshire
Correspondence to: Dr M Greenstone
Received 27 October 1999; Returned to authors 20 January 2000; Revised version received 13 April 2000; Accepted for publication 17 May 2000
BACKGROUND
Patients
with severe chronic obstructive pulmonary disease (COPD) have a poor
quality of life and limited life expectancy. This study examined
whether these patients were relatively disadvantaged in terms of
medical and social care compared with a group with inoperable lung cancer.
METHODSAn open two
group comparison was made of 50 patients with severe COPD (forced
expiratory volume in one second (FEV1) <0.75 l and at
least one admission for hypercapnic respiratory failure) and 50 patients with unresectable non-small cell lung cancer (NSCLC). A
multi-method design was used involving standardised quality of life
tools, semi-structured interviews, and review of documentation.
RESULTSThe patients
with COPD had significantly worse activities of daily living and
physical, social, and emotional functioning than the patients with
NSCLC (p<0.05). The Hospital Anxiety and Depression Scale (HADS)
scores suggested that 90% of patients with COPD suffered clinically
relevant anxiety or depression compared with 52% of patients with
NSCLC. Patients were generally satisfied with the medical care
received, but only 4% in each group were formally assessed or treated
for mental health problems. With regard to social support, the main
difference between the groups was that, while 30% of patients with
NSCLC received help from specialist palliative care services, none of
the patients with COPD had access to a similar system of specialist
care. Finally, patients in both groups reported a lack of information
from professionals regarding diagnosis, prognosis and social support,
although patients' information needs were disparate and often conflicting.
CONCLUSIONThis study
suggests that patients with end stage COPD have significantly impaired
quality of life and emotional well being which may not be as well met
as those of patients with lung cancer, nor do they receive holistic
care appropriate to their needs.
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