Wednesday, January 17, 2018
Health

For many dying elderly in bay area, aggressive cancer treatment despite their wish

TAMPA — Most seniors with terminal cancer say they want to die at home or in a hospice, surrounded by loved ones, not high- tech medical heroics.

Yet a new study finds many of them spend their final days in hospital intensive care units, or leave the hospital only a few days before they die.

What's more, researchers from the famed Dartmouth Atlas Group found, where you live may have a lot to do with what happens to you.

For example, 45 percent of senior advanced cancer patients in St. Petersburg spent time in an intensive care unit during their last month of life. But that happened to just about 10 percent of similar patients in Bismarck, N.D., and 15 percent in Colorado Springs, Colo.

On the other hand, about 19 percent of senior terminal cancer patients in Florida died in a hospital. In California, the figure was 31 percent.

These geographic variations come as no surprise to Dr. Robert Walker, director of Ethics, Humanities and Palliative Medicine at University of South Florida Health.

"This study highlights a common problem," he said. "People are still receiving very aggressive care at the end of life, when their preferences are to not go for length of life, but to choose quality of life. There's a mismatch between what patients seem to want and what they seem to get."

• • •

The Dartmouth Atlas Project, which for 20 years has documented variations in how medical resources are used, looked at Medicare cancer treatment data from 2003 to 2007 and compared it to similar data from 2010. The last month of life is frequently studied because at that point, many experts say, it should be clear whether more treatment is likely to help patients.

They saw that hospice enrollment did increase from 54.6 percent to 61.3 percent in that period for patients in their last month of life. And the number of cancer patients dying in hospitals fell from almost 29 percent to 24.7 percent.

But here's the catch: Many patients were shifted into hospice programs or sent home only days before they died. So they still had a lot of invasive care in their final month of life, rather than the comfort care many surveys indicate such patients prefer.

"Care doesn't reflect what patients want and need, but rather the practice of the region" where that care is delivered, said Dr. David Goodman, Dartmouth Atlas Project co-principal investigator.

Over the study period, admissions to the intensive care unit in the last month of life increased by 22 percent. And there was no change in the use of treatments such as CPR and chemotherapy.

Meanwhile, the number of patients admitted to hospice during the last three days of life increased from 8.3 percent to 10.9 percent over the study period. That's much too late to realize the benefits hospice offers dying patients and their families, say end-of-life experts.

The study looked at regional differences, and it also looked at individual hospitals.

At Tampa's H. Lee Moffitt Cancer Center & Research Institute, 57 percent of senior terminal cancer patients were admitted to the hospital during the last month of life in 2010. But just 8.3 percent received aggressive care, down from 14.1 percent in 2003-2007.

• • •

Dr. Lodovico Balducci, program leader of Senior Adult Oncology at Moffitt, said the change is by design.

"Many patients are getting futile care, having treatment that can result in serious side effects and complications and which is expensive but detrimental," he said. "That is just depriving them of time they should treasure.''

The Dartmouth researchers wrote that although end-of-life discussions are more common these days, some patients "might prefer more aggressive care, or do not fully understand — or accept — that their life expectancy is limited when expressing their preferences.''

That conclusion is consistent with Walker's experience. "Patients will often pursue treatment even when there is no hope for a cure, but they don't seem to know that or don't accept that," Walker said. "Everyone is different in how they face death and some don't want to hear that their prognosis is terminal."

Balducci said many patients don't known how to express their wishes and never bring the subject up with family members or their doctors.

"That conversation should start at the beginning of treatment when a patient has terminal cancer," Balducci said.

Paradoxically, patients who accept their prognosis and accept palliative care often live longer and more comfortably than those who keep seeking aggressive treatment, a 2010 New England Journal of Medicine study found.

"Some patients don't want to discuss'' end-of-life planning, Balducci said. "I've been deserted by patients for bringing it up. But I tell all of them to make a living will, choose a health care surrogate and decide whether you want CPR because that requires a separate document. It's a cruelty to resuscitate some people. That's what I convey to patients early in our discussions."

Contact Irene Maher at [email protected]

Comments
5 things we learned about Trump from his medical checkup

5 things we learned about Trump from his medical checkup

Five things we learned about President Donald Trump from Navy Rear Adm. Ronny Jackson, the doctor who oversaw Trump’s first medical checkup in office. SLEEP Trump doesn’t get much shut-eye. Jackson guessed that Trump snoozes four to five hours a nig...
Updated: 9 hours ago
A century after the 1918 pandemic, science takes its best shot at flu

A century after the 1918 pandemic, science takes its best shot at flu

WASHINGTON — The descriptions are haunting. Some victims felt fine in the morning and were dead by night. Faces turned blue as patients coughed up blood. Stacked bodies outnumbered coffins. A century after one of history’s most catastrophic disease o...
Published: 01/17/18
A popular school fundraiser is just ‘junk-food marketing to kids,’ experts say

A popular school fundraiser is just ‘junk-food marketing to kids,’ experts say

For 43 years, schoolkids and their parents have clipped the labels from cookie bags and cracker boxes as part of a popular rewards program called Labels for Education.Through this and similar programs — think Tyson’s Project A+ or General Mills’ Box ...
Published: 01/17/18
Pinellas is at the center of a rise in Florida flu outbreaks

Pinellas is at the center of a rise in Florida flu outbreaks

Feeling a little sniffly or scratchy or stuffed up? It may be the flu, and you don’t want to wait around to see a doctor this year. This is not the time to write off flu-like symptoms, Tampa Bay area health officials and doctors warn. The influenza v...
Published: 01/16/18

CDC says ‘There’s lots of flu in lots of places.’ And it’s not going away anytime soon.

A nasty flu season is in full swing across the United States, with a sharp increase in the number of older people and young children being hospitalized, federal health officials said Friday.The latest weekly data from the Centers for Disease Control ...
Published: 01/12/18
Mease Countryside Hospital begins $156M expansion project

Mease Countryside Hospital begins $156M expansion project

SAFETY HARBOR — Mease Countryside Hospital is launching a $156 million expansion to build a four-story patient tower with all private rooms and a four-story parking garage.The tower will include 70 private patient rooms, a 30-bed observation unit, cr...
Published: 01/11/18
Flu shot? This is why you should still get one this year

Flu shot? This is why you should still get one this year

This year’s flu season is shaping up to be a bad one. Much of the country endured a bitterly cold stretch, causing more people to be crowded together inside. The strain that has been most pervasive, H3N2, is nastier than most. And, we’re being told, ...
Published: 01/11/18
He was 21 and fit. He tried to push through the flu — and it killed him.

He was 21 and fit. He tried to push through the flu — and it killed him.

Kyler Baughman seemed to be the face of fitness. The 21-year-old aspiring personal trainer filled his Facebook page with photos of himself riding motorbikes and lifting weights. He once posted an image of a kettlebell with a skeleton, reading: "Cros...
Published: 01/11/18
Serena Williams tells scary story of childbirth complications

Serena Williams tells scary story of childbirth complications

The image on the cover of the February issue of Vogue features Serena Williams proudly showing off her adorable daughter.The story she tells of the changes wrought on her life by the arrival of Alexis Olympia, whom she calls by her middle name and ...
Published: 01/11/18
‘Pregnancy centers’ draw scrutiny as lawmakers seek to elevate their status

‘Pregnancy centers’ draw scrutiny as lawmakers seek to elevate their status

Annie Filkowski used to see the signs during her drive to school each morning. "Free pregnancy tests," they said.So when she feared she might be pregnant at 16, shortly after starting to have sex with her boyfriend, she remembered them. And walked in...
Published: 01/10/18
Updated: 01/12/18