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According to a recent study, despite industry guidelines that prioritize the quality of life of people with advanced disease, people with ovarian cancer often receive aggressive end-of-life care.
In fact, through 2016, intensive stays and emergency room visits in the last month of life were more common in people with ovarian cancer than in 2007, the earliest year that researchers analyzed data.
The proportion of non-Hispanic blacks who turned to the emergency room for care was even higher – twice that of non-Hispanic whites. Black people were also nearly twice as likely to receive intensive treatment, including life-prolonging measures such as resuscitation or feeding tube insertion.
“Although integrating palliative care early and reducing intensive and invasive end-of-life treatment has become more of a guideline, these recommendations do not make sufficient difference in the type of care that people with ovarian cancer receive at the end of their life, especially for humans with color, “says Megan Mullins, Ph.D., MPH, lead author of the study.
Both the American Society of Clinical Oncology and the National Academy of Medicine recommend palliative care, which focuses on relieving symptoms and improving quality of life, for those with a prognosis of less than six months.
Palliative care is particularly relevant for people with ovarian cancer as they are often diagnosed when their cancer has reached an advanced stage. Survival is unlikely at this point; Only 17% of patients with stage IV ovarian cancer live at least five years after diagnosis.
ASCO’s goal was to have cancer centers add palliative care to their treatment plans by 2020. However, the results of this study, published in Cancer, show how much work remains to be done to ensure widespread acceptance of such practices.
The researchers used the National Cancer Institute’s cancer registries known as Surveillance, Epidemiology and End Results (SEER) to examine the medical histories of nearly 8,000 people who died between 2007 and 2016. All were over 66 years old and on Medicare, and ovarian cancer was their only diagnosis of cancer.
The research team found that some end-of-life interventions are trending in a positive direction: the number of hospice enrollments has increased over time, and the proportion of people with ovarian cancer who undergo invasive procedures such as surgeries that require anesthesia has decreased .
The number of months they spend in the hospice, as well as the proportion of chemotherapy in the last two weeks of life, did not change significantly from 2007 to 2016 (longer stays in hospice are a sign that patients are comfortable with palliative care).
The overall increase in emergency room visits and intensive care stays, as well as the notable differences in certain end-of-life interventions for blacks, is disappointing, says Mullins, who is also a postdoctoral fellow at the University of Michigan’s Rogel Cancer Center and the Center for Health Improvement of patients and population at the University of Michigan School of Nursing.
“The prognosis is difficult,” says Mullins. “It is important, however, to be honest about the risks and benefits of treatment. When discussing the goals of their care with patients, they can consider how they would like to spend the remaining time.”
More research is needed, according to Mullins, to understand why aggressive end-of-life care for people with ovarian cancer persists. Explanations could be:
- emotional toll from end-of-life conversations about doctors
- Lack of understanding by patients about the effects of continuing certain cancer treatments on their quality of life
- Presence of additional chronic conditions that can worsen symptoms to the point that hospitalization is required
- the cultural preferences of the patients or the perception of the providers of them
“It is very important that we actually understand why these preferences exist and how we can address them,” says Mullins.
The hospice does not make up for the intensive treatment of ovarian cancer at the end of life
Megan A. Mullins et al., Trends and Racial Differences in Aggressive End-of-Life Care for a National Sample of Women with Ovarian Cancer, Cancer (2021). DOI: 10.1002 / cncr.33488 Provided by the University of Michigan
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