Early discussion of end-of-life care leads to less aggressive treatment and more use of hospice

Patients with advanced cancer who discussed end-of-life care with their doctors earlier in the course of their illness had care that was less aggressive in their last month of life and were more likely to use hospice services. Earlier discussions may help to ensure that care at the end of life is more consistent with patients' preferences. Yet, on average, these discussions took place about 1 month before a patient died.

Although some patients may wish to have aggressive care at the end of life, “most patients who recognize that their cancer is terminal want to receive less-aggressive care,” stated the lead investigator, Jennifer Mack, MD, MPH, of the Dana-Farber Cancer Institute.

The American Society of Clinical Oncology (ASCO) and other groups recommend that discussions about palliative and end-of-life care begin shortly after advanced cancer has been diagnosed. However, studies have found that such discussions between physicians and patients with advanced cancer are often delayed until late in a patient's life, if they take place at all.

This study analyzed interviews with patients (or patient surrogates) and medical records of more than 1,200 patients with end-stage lung or colorectal cancer regarding discussions about end-of-life care, including resuscitation and hospice care. All the patients in the study lived for at least 1 month after diagnosis and were participants in the Cancer Care Outcomes Research and Surveillance Consortium.

Almost half the patients had at least one form of aggressive care in the last month of their lives, with 16% undergoing chemotherapy within the last 2 weeks of life, 40% receiving acute hospital care within the last 30 days of life, and 6% treated in the intensive care unit in the last 30 days of life.

The patients who had end-of-life discussions earlier were much less likely to receive aggressive care and more likely to receive hospice care.

Less-aggressive care near the end of life can clearly benefit patients and their families, Mack commented. Aggressive end-of-life care has been linked to a higher risk of depression among caregivers after the patient has died. For patients, less aggressive care can mean a “better quality of life in their final days, because there is a greater focus on symptom management and they are more often able to receive care in their homes,” she said.

This research was published in Journal of Clinical Oncology (2012; doi:10.1200/JCO.2012.43.6055).
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