Advance Directives in Oncology and Haematology: A Long Way to Go—A Narrative Review

Abstract

Patients living with cancer often experience serious adverse events due to their condition or its treatments. Those events may lead to a critical care unit admission or even result in death. One of the most important but challenging parts of care is to build a care plan according to the patient’s wishes, meeting their goals and values. Advance directives (ADs) allow everyone to give their preferences in advance regarding life sustaining treatments, continuation, and withdrawal or withholding of treatments in case one is not able to speak their mind anymore. While the absence of ADs is associated with a greater probability of receiving unwanted intensive care around the end of their life, their existence correlates with the respect of the patient’s desires and their greater satisfaction. Although progress has been made to promote ADs’ completion, they are still scarcely used among cancer patients in many countries. Several limitations to their acceptance and use can be detected. Efforts should be made to provide tailored solutions for the identified hindrances. This narrative review aims to depict the situation of ADs in the oncology context, and to highlight the future areas of improvement.

Diretivas antecipadas de vontade: instrumento de autonomia para pacientes oncológicos

“…Nesse sentido, em 2018, o câncer com maior prevalência no mundo foi o de mama (11,7%), seguido pelo de pulmão (11,4%), colorretal (10%), de próstata (7,3%) e de estômago (5,6%) 19 . O câncer permanece uma condição bastante grave, apesar dos avanços terapêuticos, com a previsão de aumento de 60% em sua incidência na população mundial até 2040 20 .…”

Directivas anticipadas: un instrumento de autonomía para los pacientes oncológicos

“…En ese sentido, en el 2018, el cáncer con mayor prevalencia en el mundo fue el de mama (11,7%), seguido del cáncer de pulmón (11,4%), el cáncer colorrectal (10%), el de próstata (7,3%) y el de estómago (5,6%) 19 . El cáncer sigue siendo una enfermedad muy grave, a pesar de los avances terapéuticos, y se espera que su incidencia aumente un 60% en la población mundial para el 2040 20 .…”

Advance directives: autonomy tool for cancer patients

“…Globally, in 2018, breast cancer was the most prevalent (11.7%), followed by lung cancer (11.4%), colorectal cancer (10%), prostate cancer (7.3%), and stomach cancer (5.6%) 19 . Despite therapeutic advancements, cancer remains a serious concern, with an expected 60% increase in global cancer incidence by 2040 20 .…”