Purpose: When deciding about treatment and end-of-life care, patients with advanced lung cancer typically choose aggressive therapies, such as chemotherapy, at the cost of receiving hospice care that may increase their quality of life. The present study examined whether offering both chemotherapy and hospice together, an option which is clinically appropriate but often prohibited by hospice policies and reimbursement practices, could address this problem.

Method: 199 community-dwelling, adult smokers completed an internet-based survey in which they imagined having advanced lung cancer. Participants rated the effectiveness of four treatments (supportive care alone, chemotherapy with supportive care, hospice, and chemotherapy with hospice) at achieving four goals of treatment (extending survival, controlling symptoms, avoiding side effects, and promoting quality of life at the end of life). We used multivariate linear regression models to predict the influence of effectiveness ratings on treatment preferences.

Results: Reflecting actual treatment and end-of-life care utilization patterns of lung cancer patients, few respondents preferred supportive care alone (10%) or hospice (19%). Most preferred chemotherapy (28%) or hospice and chemotherapy together (42%). Perceived effectiveness at controlling symptoms was not associated with preferences for any treatment. Higher perceived effectiveness at extending survival and at preparation for end of life were positively associated with preferences for three of the four treatments: chemotherapy with supportive care, hospice, and chemotherapy with hospice. Perceived effectiveness at avoiding side effects was positively associated with preferences for only one treatment: chemotherapy with hospice. Regarding the strength of associations between effectiveness ratings and preferences, effectiveness ratings were weakly related to preferences for hospice, moderately related to preferences for chemotherapy, and strongly related to preferences for chemotherapy and hospice together. An increasing proportion of variance was explained for models predicting supportive care, chemotherapy alone, hospice, and chemotherapy with hospice (R2=0.02, 0.12, 0.15, and 0.28, respectively).

Conclusions: These findings suggest that interest in hospice may be low because, offered without chemotherapy, hospice is perceived as ineffective at controlling symptoms and avoiding side effects – both of which are important goals of hospice. However, offering chemotherapy and hospice together is a preferred and reasonable option for patients with advanced lung cancer. Furthermore, preferences for chemotherapy and hospice together best reflect the values people place on the goals of treatment.