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Cancer Doctors Urge Earlier End-of-Life Care Talks
Date:1/25/2011

By Serena Gordon
HealthDay Reporter

TUESDAY, Jan. 25 (HealthDay News) -- People with advanced cancer should be told what end-of-life care choices are available earlier in the course of their disease, a new policy statement from the American Society of Clinical Oncology recommends.

Unfortunately, these options are sometimes presented only days before death, reports the statement, published in the Jan. 24 issue of the Journal of Clinical Oncology.

"There's a growing body of evidence that we can and should do a better job communicating with our patients with advanced cancer," said statement author Dr. Jeffrey M. Peppercorn, an associate professor of medicine at Duke University Medical Center in Durham, N.C. "There's no one-size-fits-all approach to cancer care, but patients need to be empowered. They need to know that there are options, in most cases, for disease-directed therapy, palliative therapy directed at symptom management and clinical research trials."

Currently, the authors of the statement estimate that fewer than four in 10 cancer patients are having these types of candid discussions about all of their treatment options. What's worse is that these conversations might not be taking place until days or weeks before a patient's death.

However, these conversations should happen much earlier in the course of the cancer, according to Peppercorn. And, he added, there's some evidence that by adding supportive or palliative care to disease-directed therapies, not only is quality of life improved for patients, but they might even live longer.

Peppercorn said that "these conversations are very difficult. It's much easier for a doctor to look ahead and be optimistic when delivering treatment, but the delivery of high-quality palliative care is more difficult. We're hoping that statements, such as this one from ASCO, empower patients and doctors."

The main recommendations from the new statement include:

  • Quality of life needs to be a priority at all stages of advanced cancer care.
  • Doctors should talk with their patients about their prognosis and treatment options soon after the initial diagnosis of advanced cancer.
  • Patients should be offered the opportunity to participate in clinical trials.

Peppercorn said it's also important for doctors to understand what their patients hope to get from each treatment and what their fears are. Doctors also need to make a patient's prognosis clear, including if there are uncertainties about the prognosis.

One potential barrier to these types of in-depth conversations is time, according to the statement. But, Peppercorn said that this doesn't necessarily have to occur as one big discussion. "The depth of the conversation, how much information is provided at once and details about what will occur need to be individualized for each patient," he noted.

The statement also recommends that insurers cover the cost of advanced cancer care planning discussions, including talking about palliative care options.

"I certainly agree with this approach and the recommendations from this statement," said Dr. Steven Libutti, director of the Montefiore-Einstein Center for Cancer Care in New York City.

"The trick is reading whether or not the patient and the patient's family are ready to have these conversations. When you first sit down to discuss end-of-life care, patients and their families are rarely ready to hear that there are few options, so it's important to have these conversations in a staged way. And, I think a lot of doctors have trouble letting go, and with the idea that they can't fix it. The patient is often the one that comes to terms with the reality the quickest. The physician and the family often lag behind," said Libutti.

He added that these conversations are often a difficult balancing act. "You don't want to give false hope, but you also don't want to take away all hope, because hope is an important component in the battle."

If you have advanced cancer, and your doctor hasn't initiated this type of forthright talk about what's to come, Peppercorn said you should ask your doctor what your options are.

More information

Learn more about palliative care from the American Society of Clinical Oncologists.

SOURCES: Jeffrey M. Peppercorn, M.D., M.P.H., associate professor, medicine, Duke University Medical Center, Durham, N.C.; Steven Libutti, M.D., director, Montefiore-Einstein Center for Cancer Care, New York City; Jan. 24, 2011, Journal of Clinical Oncology


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