Recognition of Advance Directives by Advanced Cancer Patients and Medical Doctors in Hospice Care Ward

8572 Background: Despite the fact that cancer is the second leading cause of death in the US and represents the most frequent diagnosis among hospice patients, little is known about the factors that influence oncologists in their decision making around end of life care. Methods: We surveyed all clinically active medical oncology attending and fellow physicians at two affiliated academic medical centers eliciting oncologists’ attitudes and practices regarding care of cancer patients at the end of life. Included in the survey were a series of randomized vignettes describing patients with advanced solid tumors. Oncologists were asked to describe their next treatment recommendations. Results: Of the 181 oncologists contacted for survey participation, 116 (64%) returned completed questionnaires. Sixty six percent (77/116) of respondents were attending physicians and 34% (39/116) were fellows. Sixty-five percent favored concurrent treatment with third-line chemotherapy and hospice if insurance would allow. Eighty percent (93/116) agreed that patients with advanced cancer should be able to receive hospice care even if they are receiving anti-tumor therapies. Results of randomized scenarios suggest that advanced patient age was positively associated with earlier referral to hospice care and that prior treatment on a clinical trial, although not statistically significant, was modestly associated with delayed referral to hospice (1.49, 95% CI 0.71–3.11). Conclusions: Among oncologists at two academic centers, chemotherapy is an important modality for management of advanced cancer patients at the end of life. Therefore, insurance policies that prohibit chemotherapy for hospice patients may constrain oncologists in their management of such patients. No significant financial relationships to disclose.

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Pharmacologic and Non-Pharmacologic Dyspnea Management in Advanced Cancer Patients

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211040436 ◽

2021 ◽

pp. 104990912110404

Author(s):

Rachel A. Zemel

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Hospice Care ◽

Behavioral Therapy ◽

Symptomatic Treatment ◽

Advanced Cancer Patients ◽

Cancer Treatments ◽

Advanced Malignancy ◽

Breathing Exercises ◽

Oxygen Administration

As there is a high propensity for patients with advanced malignancy to experience refractory dyspnea, it is necessary for physicians to be well-versed in the management of these patients’ dyspneic symptoms. For symptomatic treatment of cancer patients with dyspnea, both pharmacologic and non-pharmacologic methods should be considered. The main source of pharmacologic symptom management for dyspnea is oral and parenteral opioids; benzodiazepines and corticosteroids may serve as helpful adjuncts alongside opioid treatments. However, oxygen administration and nebulized loop diuretics have not been shown to clinically benefit dyspneic cancer patients. Applying non-pharmacologic dyspnea management methods may be valuable palliative therapies for advanced cancer patients, as they provide benefit with negligible harm to the patient. Advantageous and minimally harmful non-pharmacologic dyspnea therapies include facial airflow, acupuncture and/or acupressure, breathing exercises, cognitive behavioral therapy, music therapy, and spiritual interventions. Thus, it is vital that physicians are prepared to provide symptomatic care for dyspnea in advanced cancer patients as to minimize suffering in this patient population during definitive cancer treatments or hospice care.

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