Causes of Death of Patients With Lung Cancer

Context.-The causes of death for patients with lung cancer are inadequately described. Objective.-To categorize the immediate and contributing causes of death for patients with lung cancer. Design.-The autopsies from 100 patients who died of lung cancer between 1990 and February 2011 were analyzed. Results.-Tumor burden was judged the immediate cause of death in 30 cases, including 26 cases of extensive metastases and 4 cases with wholly or primarily lung tumor burden (causing respiratory failure). Infection was the immediate cause of death for 20 patients, including 8 with sepsis and 12 with pneumonia. Complications of metastatic disease were the immediate causes of death in 18 cases, including 6 cases of hemopericardium from pericardial metastases, 3 from myocardial metastases, 3 from liver metastases, and 3 from brain metastases. Other immediate causes of death were pulmonary hemorrhage (12 cases), pulmonary embolism (10 cases, 2 tumor emboli), and pulmonary diffuse alveolar damage (7 cases). From a functional (pathophysiologic) perspective, respiratory failure could be regarded as the immediate cause of death (or mechanism of death) in 38 cases, usually because of a combination of lung conditions, including emphysema, airway obstruction, pneumonia, hemorrhage, embolism, resection, and lung injury in addition to the tumor. For 94 of the 100 patients, there were contributing causes of death, with an average of 2.5 contributing causes and up to 6 contributing causes of death. Conclusions.-The numerous and complex ways lung cancer kills patients pose a challenge for efforts to extend and improve their lives. (Arch Pathol Lab Med. 2012; 136: 1552-1557; doi: 10.5858/arpa.2011-0521-OA)