Aggressive cancer treatment near end of life persists

13 July 2015

New analysis has suggested that people are still having aggressive treatment to fight cancer towards the end of their life.

Researchers at Johns Hopkins University looked at nearly 2,000 surveys with people who had lost relatives to the disease and found that there has been a significant increase in the number of people who perform one type of advance care planning.

This can involve delegating power of attorney privileges and the team found there had been a 40 per cent increase over the past 12 years. However, they also determined that there had been no such corresponding impact on their rates of aggressive medical care received in the last weeks of life.

In addition, the investigators say that despite the substantial increase in patients who chose a durable power of attorney, nearly 40 per cent of the survey respondents said their loved ones did not discuss end-of-life care preferences with them.

"Although more cancer patients are assigning power of attorney privileges to someone they know and trust to make their medical decisions when they can't, this practice may be the least helpful among advance care planning tactics because it may be least associated with treatment intensity at the end of life," says Dr Amol Narang, a resident in the Department of Radiation Oncology and Molecular Radiation Sciences at The Johns Hopkins Hospital.

According to the researchers, those who did produce living wills or had end-of-life discussions were twice as likely to limit or withhold certain treatments. Although granting power of attorney did decrease the odds of terminally ill patients dying in the hospital as opposed to hospice or their home, it was not associated with treatment limitations.

The team published their results in the Journal of the American Medical Association (JAMA) Oncology.

Dr Narang said the analysis found that many cancer patients still do not communicate their preferences for end-of-life care, despite the potential benefits to patients' quality of life and caregiver bereavement.

With a drive to encourage durable power of attorney and better communication, the team say the goal is to understand the patient's preferences and provide information about alternatives to aggressive care.

The study found that nearly half (48 per cent) of patients with cancer had completed a living will, while 58 per cent had designated a power of attorney and 62 per cent had participated in end-of-life discussions. 

However, there had been no significant changes in living wills or end-of-life discussions during the 12-year period. However, there was a shift in the amount of patients who had power of attorney in 2012 (74 per cent) compared to in 2000 (54 per cent).

Posted by Edward Bartel

Health News is provided by Adfero in collaboration with Spire Healthcare. Please note that all copy above is ©Adfero Ltd. and does not reflect views or opinions of Spire Healthcare unless explicitly stated. Additional comments on the page from individual Spire consultants do not necessarily reflect the views or opinions of other consultants or Spire Healthcare.

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