Medical Assistance in Dying in Oncology Patients: A Canadian Academic Hospital Experience

Abstract

<h3>Purpose/Objective(s)</h3> Medical assistance in dying (MAID) was legislatively enacted in Canada in June 2016. MAID is performed most frequently for oncology patients. The aim of this study is to describe the patient, disease and process characteristics in this population. <h3>Materials/Methods</h3> We performed a single-institution review of all oncology patients who requested MAID at a tertiary care hospital between June 2016 and June 2020. A prospective database including patient demographics, terminal illness type, dates of assessment, cause of death, and date of death was used. Additional data such as demographic, oncologic, treatment-related, and symptom-related details were retrospectively collected. Descriptive statistics were reported. Our primary hypothesis is that performance status is one of the important factors associated with MAID provision. <h3>Results</h3> Between June 2016 and June 2020, 346 oncology patients requested and 103 received MAID. Identifiers were available and data were retrospectively collected for 92/103 patients. Median age was 72 (range 25-97) and 54% were female. The most common primary malignancies were lung (15/92, 16%), pancreaticobiliary (14/92, 16%), colorectal (13/92, 14%), and hematologic malignancy (11/92, 12%). Performance status was documented for 60 patients within 1 week of MAID provision; 90% of patients (54/60) had ECOG performance status of 3 or 4, and 42% patients (25/60) had ECOG performance status of 4. At the time of initial MAID request, 65% of patients (60/92) had metastatic disease, among which 52% of patients (31/60) received palliative-intent systemic therapy. Sixteen percent of patients with metastases (10/60) received at least 3 lines of palliative-intent systemic therapy. Median number of days from first MAID assessment to MAID provision was 7 days (range 0 to 349 days). Sixty-seven percent of patients (60/89) received MAID within 10 days of first MAID assessment and 87% (77/89) within 30 days. The most common debilitating symptoms were uncontrolled pain (53%, 49/92), fatigue (37%, 34/92), and dyspnea (27%, 25/92). <h3>Conclusion</h3> Ninety percent of oncology patients who received MAID had ECOG performance status of 3 or 4, which is reflective of patients' poor prognosis and limited ability to perform daily activity. The median time interval between first MAID assessment to MAID received was 7 days and most patients received MAID within 30 days.