When to Talk About The End

Terminal cancer patients who discuss end of life options often avoid aggressive therapy

(RxWiki News) One of the stark and sad realities of cancer is that not everybody beats it. Knowing that the end could be near and talking about it may be a wise choice for some.

Cancer patients who have early conversations with their doctor about end-of-life care are more likely to enter hospice and avoid aggressive therapies than patients who delay these discussions.

Researchers at Dana-Farber Cancer Institute found this to be the case after working with more than 1,200 patients with advanced lung and colorectal cancers.

"Insist on mutual honesty in conversations with your doctor."

“National guidelines recommend that discussions about end-of-life (EOL) care happen early for patients with incurable cancer," said the study's lead author, Jennifer Mack, MD, of Dana-Farber/Children's Hospital Cancer Center. "Our findings suggest that those guidelines are well-founded, that patients who have such discussions a month or more before death tend to receive treatment geared toward a good quality of life."

Study members were taking part in the National Cancer Institute’s Cancer Care Outcomes Research and Surveillance Consortium, which looked at many areas of cancer care. Participants or their surrogates were asked if and when discussions about EOL care had taken place.

Most patients – 88 percent – had these conversations, and 39 percent of the discussions occurred the last 30 days of their life.

People who talked frankly with their doctors about their prospects more than 30 days before death, were more likely to choose hospice care that focuses on comfort instead of cure rather than aggressive therapies such as chemotherapy.

"For patients in the final weeks of life, aggressive measures such as chemotherapy usually don't extend life, but they can lower the quality of time that remains," Dr. Mack said. "Often, when patients understand that additional aggressive treatment doesn't offer much benefit, they choose an option, such as hospice, that focuses on quality of life."

The study suggests that patients who are told they incurable cancers have more control over their care when EOL discussions take place soon after diagnosis.

Dr. Mack said that postponing these conversations until the disease is deteriorating can leave the patient’s family with making treatment decisions instead of the patient.

Decisions on whether or not to seek aggressive treatment at the end are best made, she says, before the last days of life.

This study, which was funded by National Cancer Institute, the Department of Veterans Affairs, the American Cancer Society, and the National Palliative Care Research Center, was published November 13 in the Journal of Clinical Oncology.

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Review Date: 
November 13, 2012