End-of-Life Discussions Offer Patients Benefits, Not Distress

No difference in psychological distress was found among patients with advanced cancer who reported having discussed end-of-life care with their physicians, when compared with patients who had not had such discussions, new research has found. On the contrary, such discussions were associated with positive effects on patient care.

That is according to early findings from Coping with Cancer, an ongoing, prospective, longitudinal, multi-institutional study of 603 advanced cancer patients. The study is funded by the National Cancer Institute and the National Institute of Mental Health.
“End-of-life care discussions between physicians and patients with advanced cancer are not associated with psychological distress,” reported investigators presenting at the American Society of Clinical Oncology annual meeting in June. “Furthermore, these discussions may result in increased patient understanding of illness severity, fewer invasive procedures, and lower rates of ICU admission at the end of life.”

Key findings include:
• Only 31.2% of patients reported discussing end-of-life care with their physicians.
• Patients who reported having end-of-life discussions were not more likely to meet criteria for depression or to report feeling “nervous or worried” than those who did not have such discussions.
• Patients who reported having end-of-life discussions were:
• More likely to acknowledge being terminally ill (adjusted odds ratio [AOR] = 2.24)
• More likely to value comfort care over life extension (AOR = 3.23)
• More likely to complete a do-not-resuscitate order (AOR = 3.62)
• Among the 323 patients who died, those who reported discussions about end-of-life care were more than twice as likely to enter a hospice program (AOR = 2.3). Further, these patients were less likely than those who did not discuss end-of-life care to be admitted to an ICU or to undergo ventilation.

Significant cost savings
In related findings from the Coping with Cancer study, having end-of-life discussions with physicians was associated with a 30% reduction in health care costs in the last week of life (cost difference = $874). “If extrapolated to the national level, based on the number of U.S. cancer deaths per year, these data suggest a difference in end-of-life care expenditures of $304,539,932 between individuals who had end-of-life discussions and those who did not,” note the researchers.

Source: “Medical Care and Emotional Distress Associated with Advanced Cancer Patients’ End-of-Life Discussions with Their Physicians,” Journal of Clinical Oncology; May 20, 2008 Supplement; 26(15); 2008 ASCO Annual Meeting; Abstract 6505. Wright AA, Ray A, Zhang B, et al; Dana-Farber Cancer Institute, Boston. “Associations between Advanced Cancer Patients’ End-of-Life Conversations and Cost Experiences in the Final Week of Life,” ibid., Abstract 9530. Zhang B, Wright AA, Nilsson ME, et al; Dana-Farber Cancer Institute, Boston.

Reprinted with permission from Quality of Life Matters®, copyright 2009.
Published by Quality of Life Publishing Co., Naples, FL.