Early End-of-Life Talks Can Reduce Aggressive Cancer Care

Discussing EOL plans prior to last 30 days of life linked to less aggressive, more hospice care

WEDNESDAY, Nov. 14 (HealthDay News) -- For stage IV cancer patients, end-of-life (EOL) discussions that are conducted with physicians before the last 30 days of life correlate with less aggressive care close to death and greater use of hospice care, according to a study published online Nov. 13 in the Journal of Clinical Oncology.

In order to assess the correlation between EOL characteristics and the aggressiveness of care that patients receive near death, Jennifer W. Mack, M.D., M.P.H., of the Dana-Farber Cancer Institute in Boston, and colleagues conducted a prospective cohort study involving 1,231 patients with stage IV lung or colorectal cancer who survived at least one month but died during a 15-month study period.

The researchers found that nearly half of patients received one or more markers of aggressive EOL care, including 16 percent who received chemotherapy within the last 14 days of life; 9 percent who received care in the intensive care unit in the last 30 days of life; and 40 percent who received acute hospital-based care in the last 30 days of life. The likelihood of receiving aggressive measures of care (chemotherapy, acute care, any aggressive care) at EOL was significantly lower for those patients who had EOL discussions with their physicians before the last 30 days of life. These patients also had a significantly increased likelihood of receiving hospice care and initiating hospice care earlier.

"Given the many arguments for less aggressive EOL care, earlier discussions have the potential to change the way EOL care is delivered for patients with advanced cancer and help to assure that care is consistent with patients' preferences," the authors write.

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