Aggressiveness of End‐of‐Life Care for Hospitalized Individuals with Cancer with and without Dementia: A Nationwide Matched‐Cohort Study in France

Morin, Lucas; Beaussant, Yvan; Aubry, Régis; Fastbom, Johan; Johnell, Kristina

doi:10.1111/jgs.14363

Cited by 23 publications

(23 citation statements)

References 36 publications

(61 reference statements)

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“…The number of cancer patients with dementia has seen marked increases in accordance with aging societies . Approximately 7–30% of cancer patients have dementia . Palliative care, which focuses on symptom management, psychosocial support and assistance with decision‐making, has the potential to improve the quality of care .…”

Section: Introductionmentioning

confidence: 99%

Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users

Hirooka

Nakanishi

Fukahori

et al. 2020

Geriatrics Gerontology Int

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Aim The number of cancer patients with dementia has increased markedly in accordance with aging societies. Cancer patients might receive palliative and end‐of‐life care to maintain their quality of life; however, the impact of dementia on the quality of death is unexamined in this population. Consequently, we explored the impact of dementia on the quality of death among cancer patients. Methods Home palliative care staff members completed questionnaires regarding cancer patients’ (n = 508) cognitive status, cancer‐related symptoms and quality of death using the good death inventory. Hierarchical regression analyses were carried out for the entire sample and for stratified groups based on the presence of dementia. Results Of the 508 patients, 156 (30.7%) had dementia. Hierarchical regression analyses revealed that greater quality of death was associated with not having dementia (P < 0.001). Stratified analyses showed that dying at home was related to greater quality of death both in patients with and without dementia. The presence of a primary family caregiver was associated with greater quality of death only in patients with dementia (P < 0.001). Conclusions Cancer patients with dementia were less likely to achieve a good death than those without. Our results suggest the importance of enhancing end‐of‐life care discussions with patients and their families, along with developing specific support strategies to enhance the decision‐making of cancer patients with dementia and their family members. Geriatr Gerontol Int 2020; 20: 354–359.

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Section: Introductionmentioning

confidence: 99%

Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users

Hirooka

Nakanishi

Fukahori

et al. 2020

Geriatrics Gerontology Int

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“…Do our interventions benefit or harm the general status of the patients (homeostasis, cognitive level, clinical being)? [2].…”

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confidence: 99%

“…Do our interventions benefit or harm the general status of the patients (homeostasis, cognitive level, clinical being)? [2].Terminal illness situation poses a tremendous challenge. It has been shown that dementia patients that undergo a surgical operation could be disorganized; present a dramatic sometimes fall of conscience and cognitive level and activation of depression and anxiety syndromes, with loss of their quality of life (MMSE, GCT questionnaire, McGILL Quality of Life Questionnaire).…”

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confidence: 99%

“…It is to be expected that medicine should treat a person without dementia in just the same way it should treat a person with dementia. In reality, the actual situation of the affected (ability to sustain anaesthesia, live prognosis, quality of live, overall burden) should be strongly considered, alongside with the caregivers (how to cope, economics, psychology) [1][2][3][4].In the case of mild to moderate dementia, things are easier. The patient presents a significant degree of cooperation, while somehow express his opinion on the treatment and the caregivers carry a lighter load to cope.…”

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confidence: 99%

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confidence: 99%

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Anticancer Surgical Intervention in Patients with Dementia, to Operate or Not to Operate? A Huge Ethical Dilemma

Gregory¹

2017

J Univer Surg

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A diagnosis of dementia could be frightening for those affected by the syndrome, their family members and caregivers. Dementia is the loss of cognitive functioning, which means the loss of the ability to think, remember, or reason, as well as behavioural abilities, to such an extent that it interferes with a person's daily life and activities. In fact, this is not a disease but a group of related syndromes. Dementia presents a neurodegenerative, progressively evolving, irreversible brain damage. Its symptomatology alters the patient's life in such a way that at the end he would be "another human being" with a blurred mind, doomed to die most probably by cachexia, lost in his new world. By 2050, one new case of dementias is expected to develop every 33 seconds, resulting in nearly 1 million new cases per year. Yet, other evil ailments could simultaneously appear to compose a more stressful condition. Unfortunately, the prevalence of cancer does not differ in the dementia population, and many face the agony of being treated surgically, non-invasively (chemotherapy, immunotherapy, radiation) or conservative (hormones, palliative medicine). It is to be expected that medicine should treat a person without dementia in just the same way it should treat a person with dementia. In reality, the actual situation of the affected (ability to sustain anaesthesia, live prognosis, quality of live, overall burden) should be strongly considered, alongside with the caregivers (how to cope, economics, psychology) [1][2][3][4].In the case of mild to moderate dementia, things are easier. The patient presents a significant degree of cooperation, while somehow express his opinion on the treatment and the caregivers carry a lighter load to cope. Meanwhile, life expectancy and quality of life are adequate for an interdisciplinary team (neurologist, psychiatrist, oncologist, surgeon, welfare worker, etc.) to suggest some kind of surgery. But in the case of moderate to severe dementia, especially in older individuals, a huge ethical dilemma rises among specialists and the family. To operate, or not to operate? Nevertheless, patients with mild to moderate dementia syndromes could experience postoperative cognitive decline with structural postoperative atrophy of the cortex and hippocampus, found in MRIs, mostly reversed after a time period, able though to stigmatize behavioural and cognitive qualities. Studies worldwide demonstrated that patients suffering from cancer with dementia are less likely to receive aggressive treatment (surgery, radiation) in their end of life than those who were not diagnosed with dementia. In some cases, chemotherapy combined with hormones treatment was suggested. This discrepancy raises important ethical questions for both the clinicians and the healthcare policy-makers. For example, is cancer screening necessary for patients with severe dementia syndromes? Should immunotherapy, adjuvant chemotherapy, or chemotherapy at all be administered? Should extensive surgical procedures and general anaesthesia be carried...

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Decision‐making in cancer care for people living with dementia

et al. 2020

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Objective: Increasing numbers of people are expected to live with comorbid cancer and dementia. Cancer treatment decision-making for these individuals is complex, particularly for those lacking capacity, requiring support across the cancer care pathway. There is little research to inform practice in this area. This ethnographic study reports on the cancer decision-making experiences of people with cancer and dementia, their families, and healthcare staff. Methods: Participant observations, informal conversations, semi-structured interviews, and medical note review, in two NHS trusts. Seventeen people with dementia and cancer, 22 relatives and 19 staff members participated. Results: Decision-making raised complex ethical dilemmas and challenges and raised concerns for families and staff around whether correct decisions had been made. Whose decision it was and to what extent a person with dementia and cancer was able to make decisions was complex, requiring careful and ongoing consultation and close involvement of relatives. The potential impact dementia might have on treatment understanding and toleration required additional consideration by clinicians when evaluating treatment options. Conclusions: Cancer treatment decision-making for people with dementia is challenging, should be an ongoing process and has emotional impacts for the individual, relatives, and staff. Longer, flexible, and additional appointments may be required to support decision-making by people with cancer and dementia. Evidence-based decision-making guidance on how dementia impacts cancer prognosis, treatment adherence and efficacy is required.

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Aggressiveness of End‐of‐Life Care for Hospitalized Individuals with Cancer with and without Dementia: A Nationwide Matched‐Cohort Study in France

Abstract: Older hospitalized adults with cancer with dementia are less likely to receive aggressive cancer treatment near the end of life than those without dementia. This discrepancy raises important ethical questions for clinicians and healthcare policy-makers.

Cited by 23 publications

References 36 publications

Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users

Impact of dementia on quality of death among cancer patients: An observational study of home palliative care users

Anticancer Surgical Intervention in Patients with Dementia, to Operate or Not to Operate? A Huge Ethical Dilemma

Decision‐making in cancer care for people living with dementia

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