An initiative to end-of-life decisions in cancer care

Abstract

Care of cancer patients more than often becomes limited to providing only comfort measures at the advanced stage of their diseases. Patients or family should be given accurate, relevant and comprehensible information about the goals of the treatment options. These discussions should paint a realistic picture of the outcome to be expected with specific estimates of survival and anticipated quality of life; and patients appreciate these initiatives. Discussions need to be directed toward whether intensive care unit (ICU) admission should be considered or cardiopulmonary resuscitation (CPR) be initiated for an acute cardiopulmonary arrest. A model, comprised of 16 readily variables, can be used at the time of ICU admission to estimate the probability of mortality in critically ill cancer patients. Family members and physicians agree on end-of-life decisions approximately 70% of the time. In the rest, disagreement usually centres on the physician's view that life support is futile and patient's not so clear understanding of their true prognosis despite being told by their physicians. The resolution of this conflict involves clinical ethics committees and, in extreme cases, legal counsel deliberations. Based on in-depth literature search, the present review article aims at multidisciplinary initiative to approach end-of-life care in cancer patients with comprehensive decision-making.