Smooth Transitions and Good Deaths: Unique Palliative Needs of Early Deaths Oral Squamous Cell Carcinoma

Abstract

Background: Early deaths in oral squamous cell carcinoma (OSCC) patients and their unique palliative needs are underresearched. Despite strict selection criteria for curative treatment a substantial proportion undergo transition to palliative intent treatment with early relapse and death within 12 months. There have not been many studies on their transition to palliative care and their supportive care. Aim: Analyze the palliative needs of early relapse and deaths of OSCC patients 1. Assess the most distressing symptom in this cohort of patients 2. Factors contributing to satisfactory death in this group Methods: Retrospective cohort study involving 22 oral squamous cell carcinoma patients who had died between January 2016 to December 2017 within 12 months of being diagnosed and treated with intent to cure. The demographic, staging, treatment, their symptoms, the physician-patient contact time in terms of family meetings, preferred place of death and advanced directives were extracted from the existing database. We also collected the family members opinions about factors that influenced the quality of death of the loved ones. Results: Evaluation of the symptoms that required urgent intervention in this group comprised of pain (76.3%), dyspnea (41%), poor nutrition (23%) and communication difficulties (40%). 14 (60%) required opioids for the pain control. High doses of morphine was used in patients noted to have distant metastasis. 50% of the patients in the group agreed that their preferred place of death was home. And 80% of them had all their advanced directives in place. Factors that greatly contributed to the graceful acceptance of death among the care givers are, distress management, scrupulous management of pain and symptoms during end of life and facilitating their preferred place of death. Among the various factors that we observed that contributed to caregiver satisfaction: the number of physician–family meetings were significant ( P = .0001). Conclusion: Our study confirmed the role of joint family meetings with the treating team and the palliative care with increased frequency has positive impact on the quality of death of this unique cohort of patients with short interval between relapse and death. The complex challenges in early relapse OSCC can be addressed by (1) joint care by primary treating physician and palliative care team. (2) family meetings to be initiated early and conducted more frequently with both treating team and palliative care team. (3) reduced threshold to control of symptoms by potent medication or hospitalization (4) managing the factors that give a satisfactory death in this group in terms preferred place of death, advanced directives, management of distressing symptoms in the end of life. With a more comprehensive understanding of this cohorts unique palliative needs helps the oncology and palliative teams to provide improved patient care, quality of life, smooth transition to palliative care and a good quality of death.