Trends in End-of-Life Decision Making in Patients With and Without Cancer

1. Koen Pardon⇑,
2. Kenneth Chambaere,
3. H. Roeline W. Pasman,
4. Reginald Deschepper,
5. Judith Rietjens and
6. Luc Deliens

+ Author Affiliations

1. Koen Pardon, Kenneth Chambaere, Reginald Deschepper, Judith Rietjens, Luc Deliens, End-of-Life Care Research Group, Ghent University and Vrije Universiteit (VU) Brussels, Brussels; H. Roeline W. Pasman, Luc Deliens, EMGO Institute for Health and Care Research, Expertise Center for Palliative Care, VU University Medical Center, Amsterdam, the Netherlands.

1. Corresponding author: Koen Pardon, PhD, End-of-life Care Research Group, Ghent University and Vrije Universiteit Brussels, Laarbeeklaan 103, 1090 Brussels, Belgium; e-mail: koen.pardon@vub.ac.be.

Abstract

Purpose Because of cancer's high symptom burden and specific disease course, patients with cancer are more likely than other patients to face end-of-life decisions that have possible or certain life-shortening effects (ELDs). This study examines the incidence of ELDs in patients with cancer compared with patients without cancer and the trends in ELD incidence from 1998-2007. 

Patients and Methods A nationwide death certificate study in Flanders, Belgium, was conducted in 2007, analogous to one completed in 1998. Physicians who had signed selected death certificates (n = 6,927) were sent a questionnaire. 

Results The response rate was 58.4%. Nonsudden deaths were studied. Intensified symptom alleviation occurred more in patients with cancer than in those without (53.8% v 31.7%; P < .001) as did euthanasia (6.8% v 0.9%; P < .001). There was no difference between groups in nontreatment decisions and life-ending acts without patient's explicit request. Patients with cancer were less involved in the end-of-life decision-making process than patients without cancer (69.7% v 83.5%; P = .001). From 1998 to 2007, ELD incidence has increased in patients with cancer (+6.7%) and even more in patients without cancer (+14.9%) because of an increase in intensified symptom alleviation. In patients with cancer, euthanasia rates increased strongly and life-ending acts without the patient's explicit request decreased. 

Conclusion 

The higher ELD incidence in patients with cancer compared with those without is probably related to differences in disease trajectories and access to end-of-life care. During the period from 1998 to 2007, when euthanasia was legalized and palliative care intensified, overall ELDs increased, including those as a result of symptom alleviation and euthanasia, with a decrease in life-ending acts without explicit request. 

 © 2013 by American Society of Clinical Oncology