|
 For patients with solid-tumor cancers, standards for quality
end-of-life care include not receiving chemotherapy in the last two
weeks before death, and not being intubated in the final month.
Doctors caring for patients with blood cancers like lymphoma or
leukemia believe the same standards can apply to them, too.
But most of those who responded to the survey said the reasons blood
cancer patients may not get this kind of quality end-of-life care
are because patient or doctor expectations are too high and because
doctors fear taking away a patient’s hope.
“Unlike most solid malignancies, where advanced (stage IV) disease
is incurable, many advanced (blood) cancers remain potentially
curable, which does make their situation at the end of life unique,”
said senior author Dr. Gregory A. Abel, director of the Older Adult
Hematologic Malignancy Program at Dana-Farber Cancer Institute in
Boston.
“This lack of a clear distinction between the curative and (end of
life) phase of disease for many blood cancers may serve to delay the
transition to appropriate end of life care, thus impacting quality,”
Abel said by email.
The researchers mailed 30-item surveys to 209 hematologic
oncologists in 2015 and received completed surveys from 349. Half
the doctors were over age 52 and three-quarters were men.
The doctors labeled as “acceptable” or “not acceptable” several
standard end-of-life quality measures plus two new quality measures
specific to blood cancers.
At least three quarters of the doctors all agreed that hospice
admission more than seven days before death, avoiding chemotherapy
for at least two weeks before death, and avoiding intubation or
cardiopulmonary resuscitation for at least a month before death were
acceptable measures of good end-of-life care, researchers reported
in the Journal of Clinical Oncology.
“Studies have demonstrated benefits of hospice such as improved
quality of life for cancer patients near the end of life as well as
reduced risk of psychiatric complications for bereaved caregivers;
reduction of intensive care (e.g. intensive chemotherapy close to
death) has also been shown to be associated with improved quality of
life for patients near the end of life,” Abel said.
[to top of second column] |
But these measures only happen with clear conversations between
physicians and their patients regarding prognosis, especially as
prognosis can be fluid in patients with blood cancers, he said.
“As the most common barrier cited was patient’s unrealistic
expectations about cure or prolonged life expectancy, providers can
help address this barrier by having timely and recurrent prognostic
and advance care discussions with patients well before their death
is clearly imminent,” he said.
This study didn’t consider actual end-of-life outcomes, only
doctors’ opinions, noted Kelly M. Trevino of Weill Cornell Medicine
in New York, lead author of a commentary accompanying the new study.
“I think having guidelines can be very helpful, and the important
thing is those guidelines are informed by data,” Trevino told
Reuters Health by phone.
“We should not extrapolate from this one paper that these are the
guidelines that practitioners should follow,” she said.
SOURCE: http://bit.ly/29GEZH7 Journal of Clinical Oncology, online
July 11, 2016.
[© 2016 Thomson Reuters. All rights
reserved.] Copyright 2016 Reuters. All rights reserved. This material may not be published,
broadcast, rewritten or redistributed.
 |
