Aggressiveness of Cancer Care Near the End of Life: Is It a Quality-of-Care Issue?

Abstract

A B S T R A C TThe purpose of this article is to review the literature and update analyses pertaining to the aggressiveness of cancer care near the end of life. Specifically, we will discuss trends and factors responsible for chemotherapy overuse very near death and underutilization of hospice services. Whether the concept of overly aggressive treatment represents a quality-of-care issue that is acceptable to all involved stakeholders is an open question.

Optimal indications of surgical palliation for incurable advanced gastric cancer presenting with malignant gastrointestinal obstruction

“…3. Likewise, there has recently been increasing aggressiveness for delivering chemotherapy as end-of-life therapy, aiming at prolonged OS as well as improved QOL [9,10]. In the present study, the MST of the whole patient cohort following surgical palliation was 161 days, which is similar to that of around 6 months reported in other palliative surgical literature [6,11].…”

Symptom Management in Metastatic Breast Cancer

“…Identifying which patients may actually benefit enough to undergo treatment can be difficult because there is little evidence to provide direction to the clinician [93]. Unfortunately, 20% of cancer patients are still receiving chemotherapy in the last 2 weeks of life, with many hospice referrals occurring just days before death [94]. Patient-centered communication during this phase of care is focused on eliciting the patient's report of symptoms; communicating prognosis while maintaining hope; making decisions about anticancer treatments, life support, substituted judgment, and hospice care; responding to the emotions of the patient, family, and caregivers; and helping the patient navigate the transition to hospice care [95].…”

Dialysis in the Frail Elderly — A Current Ethical Problem, an Impending Ethical Crisis

“…17,19 The symptom burden in the elderly HD patient is heavy and rivals that of cancer, 14 yet palliative care is underutilized, even in patients who withdraw from HD. 57 Death associated with discontinuation of HD has increased from 14 % of patients 65 59 Survival of elderly patients on HD is poor. 6 A recent push toward earlier initiation of HD has failed to improve survival.…”

“…In addition to rapidly aging demographics, there has also been increasing intensity of care for the elderly and terminally ill in the past decades. 65,66 Between 1997 and 2003, there was a 57 % age-adjusted increase of HD initiation in octogenarians and nonagenarians. 7 This trend contributes to runaway costs that threaten the solvency of Medicare.…”