Dying Patients Need Better Palliative Care

A survey of 900 oncologists has shown that although almost all (92%) agree that dying patients and patients with advanced cancer should receive end-of-life support as well as antitumor therapy, fewer than half routinely coordinate the care of cancer patients at all stages of their disease or collaborate with support teams and social workers. The results of the survey, conducted by the European Society for Medical Oncology (ESMO, Viganello-Lugano, Switzerland) in 64 countries, were presented at ESMO's annual congress in Nice (France).

"There is a big gulf between what people say and what they do,” said Dr. Nathan Cherny, of Shaare Zedek Medical Center in Jerusalem (Israel), who coordinated the survey. "Although there is general recognition that palliative care is important, many oncologists do not see this as an integral part of their role.”

Patients nearing the end of their life due to cancer require extra care for problems such as pain and digestive disorders, anxiety and depression, and complications following chemotherapy. The family members should also be involved with their care and it may be appropriate for the patient to be admitted to a hospice.

A significant minority (15%) of medical oncologists had negative views of the value of palliative care, partly because they did not believe they were sufficiently trained to deal with dying patients and did not consider it to be part of their role. More than one-third of the respondents reported feeling emotionally "burned-out” by having to deal with too many deaths, but an analysis revealed that burn-out was not so much associated with over-exposure to dying people as with a negative attitude towards the value of palliative care. By contrast, those with a positive attitude had a great deal more personal involvement with patients, yet appeared to be much less likely to feel drained by their experience.

"Physicians who have had bad experiences administering end-of-life care should be given advice and psychological support to help them communicate more effectively with severely ill patients, said Dr. Cherny.

ESMO has produced a policy reflecting its commitment to improving the care of dying patients. The policy outlines ethical issues related to disclosure of information, consent, and decision-making. Minimal standards for the provision of care by cancer centers include: routine assessment, control and evaluation of physical and psychological symptoms; emergency care; and ongoing supportive programs, social work, and psychologic care.



Related Links:
European Society for Medical Oncology