Incidence and risk factors for euthanasia or physician-assisted suicide in oncology patients: A systematic review.

Abstract

12034 Background: In a growing number of jurisdictions, oncology patients may choose euthanasia or physician-assisted suicide (EPAS). A 2016 systematic review reported that 75% of U.S. and over 70% of Dutch and Belgian EPAS cases involved oncology patients. In the Netherlands and Belgium, the percentage of deaths among oncology patients via EPAS has been increasing. We investigated the incidence and risk factors for EPAS and EPAS requests in oncology patients. Methods: A systematic review was performed following PRISMA guidelines. PubMed, Embase and Cochrane databases were searched for articles from January 2000 to April 2020. Search terms were related to suicide, euthanasia, assisted dying, assisted death, right to die, mercy killing, and cancer. Eligible studies reported incidence and/or risk factors for EPAS/EPAS request based on at least 50 oncology patients. Eligibility for inclusion was independently reviewed by two authors, with discrepancies adjudicated by a third. Data obtained included: study type, country, cancer diagnosis, number of eligible patients, inclusion criteria, follow-up length, incidence of EPAS or EPAS request, and odds ratios (OR) for risk factors for EPAS and EPAS request. ORs and p values were extracted from studies whenever possible and were otherwise calculated based on the data provided using chi-squared test. Results: The search strategy identified 6519 results. 25 abstracts were selected for full-text review and 10 studies were included for analysis. All studies reported incidence of EPAS/EPAS request and 6 studies reported risk factors for EPAS/EPAS request. Six studies were from the Netherlands, 3 from Belgium, and 1 from Canada. Inclusion period for studies spanned from 1996 to 2018. Half of the included studies were prospectively conducted. Incidence of EPAS in cancer patients ranged from 7% to 15% and EPAS requests ranged from 8% to 27%. Factors significantly associated (p<0.05) with EPAS or EPAS request in any study are shown in the Table. Conclusions: Up to 15% of oncology patients choose euthanasia or physician-assisted suicide. Potentially modifiable symptoms including severe nausea, vomiting, and pain are significantly associated with EPAS in oncology patients.[Table: see text]