End-of-Life Care

Delirium is highly prevalent in cancer patients with advanced disease. Frequently a preterminal event, the condition is a sign of significant physiologic disturbance, typically involving multiple medical etiologies including infection, organ failure, adverse medication effects, and in rare situations, paraneoplastic syndromes. Unfortunately, delirium is frequently underrecognized or misdiagnosed and, therefore, inappropriately treated or untreated in terminally ill patients. The clinical features of delirium are numerous and encompass a variety of neuropsychiatric symptoms common to other psychiatric disorders. Three clinical subtypes of delirium, based on arousal disturbance and psychomotor behavior, have been described: hyperactive, hypoactive, and mixed. The differential diagnosis for delirium includes depression, mania, psychosis, and dementia. Numerous instruments have been developed to aid the clinician in rapidly screening for the disorder. Standard management requires an investigation of the etiologies, correction of the contributing factors, and management of symptoms. Symptomatic and supportive therapies, including numerous pharmacologic approaches, are important, but several aspects of the use of neuroleptics and other agents in the management of delirium in the dying patient remain controversial.

The term “supportive oncology” refers to those aspects of medical care concerned with the physical, psychosocial, and spiritual issues faced by persons with cancer, their families, their communities, and their healthcare providers. In this context, supportive oncology describes both those interventions used to support patients who experience adverse effects caused by antineoplastic therapies and those interventions now considered under the broad rubric of palliative care. At its core, palliative care is concerned with providing the maximum quality of life to the patient/family unit.

A federal judge in Oregon has temporarily blocked Attorney General John Ashcroft’s ability to prosecute Oregon physicians who use controlled substances to help a patient in pain end his or her life. Mr. Ashcroft’s announcement in early

If he needed more encouragement than the California verdict, Sen.Wyden (D-Ore) got it a week later when the National

SAN FRANCISCO—More than four out of 10 cancer patients received chemotherapy during their last year of life, according to a study of Medicare patients in Massachusetts. Even a proportion of patients with tumors considered unresponsive to chemotherapy received treatments within 1 month of their death.

Sedation is a clinically important therapeutic intervention in the imminently dying patient. As the patient with an advanced, irreversible illness nears the end of life, symptoms accumulate that are progressively more difficult to

CLEVELAND—While the majority of Americans wish to die in the comfort of their homes, most are actually dying in institutions, often with pain and other symptoms poorly controlled.

Peaceful Dying is a work of considerable effort and organization. Dr. Tobin has painstakingly analyzed his experience as a physician caring for patients with terminal illness and compiled a step-by-step guide to help both patients and their families

Predicting the survival of terminal cancer patients is a difficult task. To better understand this difficulty, we divide prognostication into two distinct elements: foreseeing and foretelling. Foreseeing is a physician’s silent cognitive

Because most patients now want to know the truth about their diagnosis and prognosis, the ability to discuss the cancer diagnosis, disease recurrence, or treatment failure, and to solicit patients’ views about resuscitation