Symptom Burden and Complexity in the Last 12 Months of Life among Cancer Patients Choosing Medical Assistance in Dying (MAID) in Alberta, Canada

Abstract

Background: In 2019, cancer patients comprised over 65% of all individuals who requested and received Medical Assistance in Dying (MAID) in Canada. This descriptive study sought to understand the self-reported symptom burden and complexity of cancer patients in the 12 months prior to receiving MAID in Alberta. Methods: Between July 2017 and January 2019, 337 cancer patients received MAID in Alberta. Patient characteristics were descriptively analyzed. As such, 193 patients (57.3%) completed at least one routine symptom-reporting questionnaire in their last year of life. Mixed effects models and generalized estimating equations were utilized to examine the trajectories of individual symptoms and overall symptom complexity within the cohort over this time. Results: The results revealed that all nine self-reported symptoms, and the overall symptom complexity of the cohort, increased as patients’ MAID provision date approached, particularly in the last 3 months of life. While less than 20% of patients experienced high symptom complexity 12 months prior to MAID, this increased to 60% in the month of MAID provision. Conclusions: Cancer patients in this cohort experienced increased symptom burden and complexity leading up to their death. These findings could serve as a flag to clinicians to closely monitor advanced cancer patients’ symptoms, and provide appropriate support and interventions as needed.

End-of-Life Symptom Burden among Patients with Cancer Who Were Provided Medical Assistance in Dying (MAID): A Longitudinal Propensity-Score-Matched Cohort Study

“…ESAS-r symptom scores from PROs questionnaires were ordered from 12 months before death ("12") to 1 month before death ("1"). When more than one PRO questionnaire was completed by a patient in a single month, the questionnaire with higher symptom scores was selected, as is consistent with published research using similar methods [21,35]. Data were assumed to be missing at random, as is common when using real-world mortality data [36].…”

“…Recent evidence suggests that patients with cancer who are provided MAID report significant increases in symptom burden in the last year of their life [21]. However, it is not known how this increasing pattern of symptoms may be similar or different from those with cancer who die without the provision of MAID.…”

Examining assisted suicide and euthanasia through the lens of healthcare quality

“…Two-thirds had EAS carried out the same month they requested it. During the last month of life, the majority of patients (close to 60%) had a high symptom burden [ 41 ].…”