Early end-of-life talks mean less aggressive care later
End-of-life (EOL) discussions that take place between persons with cancer and their health providers before the period immediately preceding the patient's death are prospectively associated with less aggressive care and greater use of hospice services when the patient does actually reach his or her final days, researchers have learned.
Jennifer W. Mack, MD, MPH, of the Dana-Farber Cancer Institute in Boston, Massachusetts, and colleagues conducted a prospective study of 1,231 persons with stage IV lung or colorectal cancer. The patients all died during the course of the 15-month study period after surviving at least 1 month.
As Mack's group described in Journal of Clinical Oncology, 88% of the patients had EOL discussions, with 39% of those discussions taking place in the 30 days before death. Nearly half the patients in the study received at least one marker of aggressive EOL care:
- acute hospital-based care in the last 30 days of life (40%)
- chemotherapy in the final 14 days of life (16%)
- intensive-care-unit care in the final 30 days of life (9%).
Patients who discussed EOL care with their physicians before the final 30 days of life were less likely to receive aggressive measures at EOL, more likely to receive hospice care, and more likely to have hospice care initiated earlier.
“National guidelines recommend that discussions about end-of-life care happen early for patients with incurable cancer,” noted Mack in a statement issued by Dana-Farber Cancer Institute. “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.”