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While most patients who are terminally ill with cancer retain their will to live, some report a desire to hasten their dying. But little is known about the relationships of this desire to other variables, whether it changes over time, or whether caregiving by a spouse influences a patient's attitude.


As part of a larger study on spouses of patients with cancer, researchers surveyed patients with late-stage cancer (virtually all white, two-thirds male, with a mean age of 63 years), measuring depression, attitude toward "hastened death," spiritual well-being, marital satisfaction, and symptom distress. Half of the patients had lung cancer and 90% had received chemotherapy. Their spouse caregivers completed surveys on the number of hours spent providing care and how this altered other activities, including work schedules and social relationships. Almost 180 couples initially consented to participate, but attrition was high: the final sample consisted of 60 couples.


On average, the patients did not have high levels of desire to hasten death. Those experiencing higher levels also had higher levels of depression and symptom distress and lower levels of spiritual well-being; their caregivers also reported higher levels of stress. Caregivers reported spending almost 40 hours a week providing care, reporting low-to-moderate degrees of stress from caregiving.


When the patients were surveyed again approximately four months later, an increased desire for death was found to be associated with a higher level of depression, more hours required for caregiving, and greater marital satisfaction. This last finding was a surprise, and the authors suggest that it may indicate a desire of the ailing patient to avoid burdening the spouse.


The authors caution that their findings of low levels of desire to hasten death are inconsistent with other studies, perhaps because of differences in the setting (ambulatory versus institutional) and the degree of physical limitations of the patients. They also acknowledge the homogeneity and small sample of this study as limitations. They do note however, that when planning interventions for people with advanced cancer, health care providers "should consider aspects of the marital and the caregiving relationships that might lead a patient to experience heightened distress at the end of life."


Ransom S, et al. Ann Behav Med 2006;31(1):63-9.