慢阻肺（COPD）并发肺癌的患者可能因预后不良和症状负担较重而需要更多的姑息疗护。我们旨在比较不同COPD状态下的及时姑息护理提供情况和症状负担。我们利用健康管理数据库和癌症登记簿对加拿大安大略省（2009-2019年）被诊断患有肺癌的个体进行了一项回顾性的基于人群的队列研究。通过考虑死亡作为一种竞争事件来确定COPD对接受姑息护理的概率的影响，无论总体情况还是按分期分层。我们比较了患有严重症状（Edmonton症状评估量表评分≥7）的患者的姑息护理提供情况、第一次姑息护理就诊地点和症状严重程度与COPD状态的关系。研究纳入了74,993名患者（48%患者有可用的症状数据）。在肺癌诊断时，50%的患者同时患有COPD。患有COPD的I-III期患者更有可能接受姑息护理（调整风险比（HR）：1.05至1.31），而IV期患者没有差异（1.02，95% CI：1.00至1.04）。虽然早期患者存在严重症状，但很少有患者接受姑息护理（I期：COPD-23% vs. 无COPD-18%，效应量=0.12）。大多数患者（84%）报告了严重症状，COPD尤其在早期患者中加重了症状负担。COPD影响了早期肺癌患者接受姑息护理和症状负担。许多有严重症状的患者并未接受姑息护理，表明这一弱势人群存在未满足的需求。版权©2023。由Elsevier Inc.出版。

Lung cancer patients with chronic obstructive pulmonary disease (COPD) may have greater palliative care needs due to poor prognosis and symptom burden.We sought to compare the provision of timely palliative care and symptom burden by COPD status.We performed a retrospective, population-based cohort study of individuals diagnosed with lung cancer in Ontario, Canada (2009 - 2019) using health administrative databases and cancer registries. The impact of COPD on the probability of receiving palliative care was determined accounting for dying as a competing event, overall and stratified by stage. The provision of palliative care for patients with severe symptoms (Edmonton Symptom Assessment Scale score ≥ 7), location of the first palliative care visit and symptom severity were compared by COPD status.74,993 patients were included in the study (48% of patients had available symptom data). At the time of lung cancer diagnosis, 50% of patients had COPD. Stage I-III patients with COPD were more likely to receive palliative care (adjusted Hazard Ratio (HR)s: 1.05 to 1.31) with no difference for stage IV (1.02, 95% CI: 1.00 to 1.04). Despite having severe symptoms, very few patients with early-stage disease received palliative care (Stage I: COPD-23% vs. no COPD-18%, SMD=0.12). Most patients (84%) reported severe symptoms and COPD worsened symptom burden, especially among early-stage patients.COPD impacts the receipt of palliative care and symptom burden for patients with early-stage lung cancer. Many patients with severe symptoms did not receive palliative care, suggesting unmet needs among this vulnerable population.Copyright © 2023. Published by Elsevier Inc.