Mood and Anxiety Symptoms among Advanced Cancer Patients: Kids Matter (720)

Abstract

Objectives 1. Recognize that patients with metastatic spinal cord compression have limited life span. 2. Recognize that very low percentage of patients with metastatic spinal cord compression had advanced care plan in a tertiary cancer center. 3. Discuss the urgency to initiate an earnest and close dialogue between the treating physician and his patient. I. Background. End-of-life communication is crucial because most U.S. hospitals implement cardiopulmonary resuscitation (CPR) in the absence of do-not-resuscitate directives (DNRs). Metastatic spinal cord compression (MSCC) has a median survival time of 3e6 months; yet there is little DNR utilization data in this population. II. Research Objectives. The objective of this study was to determine DNR utilization patterns in cancer patients with MSCC. III. Methods. A retrospective database analysis (March 2003eJune 2008) of DNR data for 88 cancer patients who had MSCC and required rehabilitation consultation at M. D. Anderson Cancer Center (MDACC) was performed. IV. Results. The mean age of this patient population was 54-years-old (range 14e81). Thirty patients were female (33%), 20 patients (23%) had a living will, 27 patients (31%) had identified a healthcare proxy, and 5 patients (6%) had DNR directives. The median survival for these patients was 4.2 months. V. Conclusion. Even with strong evidence showing the median life span of MSCC patients is 3e6 months; it seems many patients are not aware of the urgency to have an advance directive. This may be an indicator of delayed end-of-life palliative care and suboptimal doctor-patient communication. Using this catastrophic event to trigger communication and initiate palliative care may be beneficial. VI. Implications for Research, Policy, or Practice. Clinicians can be better equipped with evidence on cancer patients’ prognosis and apply it when initiating end-of-life conversations with cancer patients.