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Comfort should be focus of late ovarian cancer care
NEW YORK (Reuters Health) - The results of a new study suggest that even aggressive treatments do not improve survival for women with advanced ovarian cancer. Thus, the focus should be on making the patient's remaining days as comfortable as possible.
"In ovarian cancer patients, there is a pattern as patients approach the end of life," Dr. Vivian von Gruenigen from University Hospitals Case Medical Center, Cleveland, Ohio, told Reuters Health. "They have increased hospitalizations and undergo more (procedures) for symptoms."
This should be the signal to shift the emphasis from cure-oriented care to end-of-life care, relieving pain and making the patients comfortable, also referred to as palliative care, von Gruenigen and colleagues advise in the journal Cancer.
The researchers identified characteristics that indicated ovarian cancer patients were approaching the end of life, and they evaluated trends in hospice transfer. To this end, they reviewed the medical charts of 113 women with ovarian cancer.
Just under half the patients died at home, with or without hospice support, the team found.
Hospice care was received by more patients who died between 2003 and 2006 than by those who died between 2000 and 2002.
More patients who received chemotherapy during the last 3 months of life died in the hospital, compared with patients who did not receive chemotherapy during this time, the report indicates.
Patients experienced more hospitalizations and significant clinical events as they approached the end of life. Patients with a shorter survival time had a trend toward receiving more chemotherapy and more aggressive care during their last 3 months of life, the researchers note. More aggressive care did not affect the frequency of significant clinical events.
"Once their cancer recurs, the oncologist should start a dialog with the patient in regards to the trajectory of their disease," von Gruenigen said. "As their remissions are shorter and these clinical indicators increase, conversations about the end of life should increase."
"I recommend hospice to all of my patients as their journey comes to a close," she added.
SOURCE: Cancer, May 2008.
