P27 - End of life in cancer patients: something more?

Abstract

End of life in cancer patients brings us to an ethical evaluation not only concerning the patient but also regarding society since prolonging therapies which are sometimes very expensive, means an improper use of resources which could be used to help patients who could gain a real advantage from them. Many studies suggest that optimal palliative care can effectively manage the symptoms of most cancer patients during most of the course of the disease. A particularly difficult problem is palliative sedation; in fact apart from the most common symptoms such as pain, dyspnoea and anxiety, palliative sedation is the last resort used at the end of life to relieve severe and refractory symptoms. The objective of this treatment is to relieve the burden of unacceptable and unnecessary suffering for terminal cancer patients and to do so in such a manner to preserve the moral sensibilities of the patient, the medical professionals involved in his or her care and concerned family and friends. Before teaching techniques to control the most common symptoms in terminal cancer patients such as pain, dyspnoea, anxiety and palliative sedation it is important to empathize a culture focused on the doctor-patient relationship The current lack of definition of best practices could explain the difficulties facing the attending oncologist and consequently, at least in part, the high number of patients who request further therapy in the final stage of the illness even though the advantages in terms of survival will most probably be minimal or totally absent: they continue to cling to this illusion. However, inevitably we must ask ourselves who has the absolute right to deprive someone of an irrational hope. Patients have the right to accept or reject therapy and more often than not continue to hope even though the situation may be hopeless. The role of the doctor is not to offer hope which is only an illusion but, and this is probably the most crucial point in the doctor/patient relationship, the doctor must help patients reduce their expectations while, at the same time, heighten the patient's trust in the doctor and to comfort patients in the knowledge that they are not alone, and that their physical and psychological suffering will be the doctor's only concern. At the beginning of the twentieth century Franz Kafka frequently said: “It's easy to write a prescription for medicine but talking to people who are suffering or dying is more, much more difficult”.