Initiating discussions about end-of-life care with patients with incurable cancers early in their disease was associated with a decrease in late-stage aggressive cancer treatments such as chemotherapy or acute care, and with an increase in the use of hospice care at the end of life.
Giving patients at the end of life regular parenteral hydration of 1 L of saline per day did not improve symptoms associated with hydration, quality of life, or survival, according to a randomized, placebo controlled study.
Although the number of metastatic cancer patients receiving radiation in the last year of life did not significantly change from 2000 to 2007, a new study has found a shift in radiation use from the simplest radiation treatments to more advanced treatment.
A new study in the United Kingdom has found an increasing trend in opioid prescribing by general practitioners for cancer pain during a patient’s last 3 months of life. However, data also revealed that older patients had a significantly lower chance of receiving opioids to address cancer pain compared with patients aged 50 years or younger.
A significant portion of patients with incurable lung cancer believe that palliative radiation therapy will cure the disease or at least help them live longer, according to a new study. Only about one-third of patients acknowledged that the treatment was not at all likely to cure their cancer.
Adolescents and young adults want to be more involved in specific aspects of their end-of-life care and found a planning document to aid in those decisions helpful, according to the results of a recently published study.
When facing decisions involving children with cancer at the end of life, three themes drove parental decision making--communication, extending time, and understanding prognosis, according to a recent meta-analysis.
I have come to the conclusion that a successful systematic approach to earlier transitions from disease-directed cancer therapy to end-of-life and palliative care can only come from better communication in the context of more trusting relationships.
The evidence base for the diagnosis and management of amyotrophic lateral sclerosis (ALS) is weak.|To provide evidence-based or expert recommendations for the diagnosis and management of ALS based on a literature search and the consensus of an expert panel.|All available medical reference systems were searched, and original papers, meta-analyses, review papers, book chapters and guidelines recommendations were reviewed. The final literature search was performed in February 2011. Recommendations were reached by consensus.|Patients with symptoms suggestive of ALS should be assessed as soon as possible by an experienced neurologist. Early diagnosis should be pursued, and investigations, including neurophysiology, performed with a high priority. The patient should be informed of the diagnosis by a consultant with a good knowledge of the patient and the disease. Following diagnosis, the patient and relatives/carers should receive regular support from a multidisciplinary care team.
As terminal disease progresses, health deteriorates and the endoflife approaches, people may ask "Why this illness? Why me? Why now?" Such questions may invoke, rekindle or intensify spiritual or religious concerns. Although the processes by which these associations occur are poorly understood, there is some research evidence for associations that are mainly positive between spiritual and religious awareness and wellness, such as emotional health.|This review aimed to describe spiritual and religious interventions for adults in the terminal phase of a disease and to evaluate their effectiveness on well-being.|We searched 14 databases to November 2011, including the Cochrane Central Register of Controlled Trials and MEDLINE.|We included randomised controlled trials (RCTS) if they involved adults in the terminal phase of a disease and if they evaluated outcomes for an intervention that had a spiritual or religious component. Primary outcomes were well-being, coping with the disease
William S. Breitbard, MD, acting chair at the department of psychiatry and behavioral sciences and chief of psychiatry service at Memorial Sloan-Kettering Cancer Center, discusses how to have an effective end-of-life conversation with a patient.