End-of-life care—what do cancer patients want?

Abstract

Patients with cancer frequently suffer from debilitating physical symptoms and psychological distress, particularly at the end of life. Interventions to help alleviate these problems are often complex and multifactorial. Palliative care services and therapeutic interventions have developed in a variable manner, often with limited evaluation of clinical effectiveness and affordability, resulting in a relatively weak evidence base. The health care provided to patients with advanced-stage cancer does not always correlate with what is known about their preferences for care. In this Review, we discuss the preferences of patients with cancer regarding their end of life care, including the importance of early provision of palliative care, and the central role of advance care planning in meeting patients' preferences. It has been shown that many patients with cancer wish to die at home. We discuss the factors that contribute to the place of death, including environmental factors, disease-specific issues, and the availability of resources. There has been a recent upward trend in the number of patients with cancer who die in their preferred place of care, and important contributors--such as community palliative care, advance care planning, and improvements in palliative care services as a result of robust research studies--are considered.

Association of Expanded VA Hospice Care With Aggressive Care and Cost for Veterans With Advanced Lung Cancer

“…Nonetheless, the percentage of hospice recipients enrolled in hospice for 7 days or less has remained around 30% despite many efforts to encourage earlier entry into hospice. 3 Some suggest that the terrible choice inherent in Medicare’s requirement to essentially give up further disease-modifying treatment is 1 reason that many patients enter hospice so late. 4,5 Studies of palliative care for patients with cancer provided before hospice, including at the time of diagnosis with late-stage disease, have repeatedly revealed improved patient outcomes, including earlier hospice referral and lower costs relative to usual care.…”

Evaluating the Effects of Inpatient Palliative Care Consultations on Subsequent Hospice Use and Place of Death in Patients With Advanced GI Cancers

“…8,9 Our study addresses this gap in care by linking inpatient palliative care consultations to hospice use, especially at the time of death, when its resources are so crucial not only to patients, but also to their family members and caregivers. Hospice still remains an underused resource despite its demonstrated ability to improve quality of care and patient satisfaction and reduce costs.…”

Future cancer research priorities in the USA: a Lancet Oncology Commission

“…The US National Institutes of Nursing Research does a lot of research on end-of-life issues and have identified the following research gaps: living with uncertainty; the costs of caregiving; communication; interventions for ethnically and culturally diverse populations; and transitions in care. 214,215 We have much to learn from our patients 216,217 and our European colleagues 218 in this area. Although some foundations fund end-of-life research, 219 overall federal funding for end-of-life research is small and should be expanded.…”