End-of-life of patients with idiopathic pulmonary fibrosis treated with antifibrotic therapy

<bold>Background:</bold> Idiopathic pulmonary fibrosis (IPF) is a progressive disease with high symptom burden and poor prognosis. Although antifibrotic drugs have become available, end-of-life of the patients who received antifibrotic treatment is unclear. Objectives: We aimed to describe the end-of-life situation of IPF patients, focused on location of death and hospitalization. <bold>Methods:</bold> The multicenter study included 110 consecutive deceased patients who received antifibrotic drugs between 2009 and 2018 in Gunma prefecture, Japan. We retrospectively analyzed their medical records. <bold>Results:</bold> The majority of the patients (n=87/110) died in a specialized respiratory ward. Patients were hospitalized for 77(0-387) days. Collaboration between pulmonary specialists and palliative care specialists were rarely documented. Acute exacerbation was significantly associated with death in the respiratory ward (HR=2.21, P=0.006), while pneumothorax was significantly associated with prolonged hospital stay (more than 3 months) (HR=2.56, P=0.02). <bold>Conclusion:</bold> For IPF patients who had a history of taking anti-fibrotic drugs, the options for location of death were limited. The patient-centered team approach, including the discussion on management policies for complications and interprofessional collaboration between pulmonologists and palliative care specialist, may lead to better end-of-life of IPF patients.