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THE IMPORTANCE OF ADVANCE CARE PLANNING WITH CANCER PATIENTS

By 02/11/2019 November 3rd, 2019 No Comments

February is National Cancer Prevention Month, a designated time to shed light on the importance of promoting overall health, and utilizing preventative care to diagnose and treat cancer early on. While these measures have saved many lives, cancer is still the second leading cause of death in the United States. A diagnoses of cancer uprooted the lives of roughly 1.7 million Americans last year. Of those newly diagnosed cases, 600,000 people are expected to die. The unpredictable trajectory of this disease often hinders the ability of patients to document their final wishes prior to losing their battle with the disease.

According to the International Agency for Research on Cancer, the number of new cancer cases per year is expected to rise to 23.6 million by 2030, emphasizing the importance of advance care planning (ACP) measures among this vulnerable population. Cancer can rapidly progress, therefore, it is vital for ACP conversations to occur early in a patient’s battle and should be revisited frequently throughout treatment. Appropriate ACP documentation should be completed, such as an advance directive, a goals of care, or a POLST form, and should be made available to all providing care to that patient.

Studies have found that ACP is often not a top priority for medical personnel. A cohort study on 2,155 patients with stage IV lung or colorectal cancer noted that oncologists discussed end-of-life issues with only about a quarter of patients with non-small-cell lung cancer, and more than half of these discussions took place in an inpatient setting, an average of 33 days before death. National guidelines recommend physicians discuss end-of-life care planning with patients who have incurable cancer and a life expectancy of less than one year. Addressing death wishes is inherently difficult, but if approached early, patients can ensure their wishes are known and honored.

Providers take an oath to care and advocate for their patients’ best interest. Based on an analysis of 28,777 Medicare claims, researchers were able to conduct surveys on the aggressiveness of end-of-life (EOL) cancer treatment for older adults, and its relationship to access of healthcare resources. A group of researchers then highlighted the five main values of EOL patients being: (1) Receiving adequate pain and symptom management (2) Avoiding inappropriate prolongation of dying (3) Achieving a sense of control (4) Relieving burden and (5) Strengthening relationships with loved ones.

The healthcare industry is shifting towards becoming more patient-centered and value driven.
Patients are becoming more involved in their health through shared and informed decision making. More and more patients are broaching the subject with their providers, making them responsible for discussing end-of-life options with their patients.

Routine ACP discussions with patients will inevitably improve patient and family satisfaction. All individuals want to feel like their dignity is respected. Cancer and other terminal illnesses can strip patients of this. ACP programs, however, help patients regain some autonomy and control over their the time they have left.