Early end-of-life talks tied to less aggressive care: study

Mon Nov 12, 2012 8:12pm EST

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Nov 13 (Reuters) - Terminally-ill cancer patients are less likely to get aggressive end-of-life treatment, such as chemotherapy in the last two weeks of life, when they talk with their doctors early on about how they want to die, according to a U.S. study.

The analysis, which appeared in the Journal of Clinical Oncology, involved 1,231 people with advanced lung or colon cancer who died over a 14-month period during a larger cancer study. Researchers interviewed patients or their care-givers about whether and when the patients had discussions with their doctors about end-of-life care.

Treatment aimed at keeping those patients alive at the end is often expensive and may not improve their quality of life or comfort. It also may involve more time in the hospital rather than at home or in hospice care.

"Aggressive care at the end of life for individual patients isn't necessarily bad, it's just that most patients who recognize they're dying don't want to receive that kind of care," said lead author Jennifer Mack, at the Dana-Farber Cancer Institute in Boston.

Mack and her colleagues also checked medical records for signs of end-of-life discussions and for any treatment and hospitalizations cancer patients had in their last month of life.

They found that most patients - 88 percent - had end-of-life discussions, but more than one-third of those took place less than a month before the patient died, when their health was likely already deteriorating. Close to two-thirds of the talks happened when the patients were in the hospital.

Almost half of the study participants received aggressive, life-prolonging care, Mack's team said.

But those who'd had end-of-life discussions more than a month before dying were 50 to 60 percent less likely to get that extra treatment than patients who put off those talks or didn't have them at all.

Patients and caregivers who reported having the discussions with doctors were almost seven times more likely to end up in hospice than those who didn't recall end-of-life talks.

"A lot of patients don't want (aggressive treatment), but they don't recognized that they're dying or that this is relevant for them, said Camilla Zimmermann, head of the palliative care program at University Health Network in Toronto.

"The earlier you discuss these things, the more options you have. If you wait too long, you end up having these discussions with someone you don't know, that you just met, in an inpatient setting."

Zimmermann, who wasn't involved in the study, believes it's never to early to initiated discussions about end-of-life preferences, even though it can be uncomfortable.

"I think people are afraid that bringing up these discussions is going to make them die," she said. "Bringing up these discussions is really going to protect them from an outcome they don't want in the end." SOURCE: bit.ly/qPtMdm (Reporting from New York by Genevra Pittman at Reuters Health; editing by Elaine Lies)

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