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More candor urged in care of dying cancer patients

Associated Press | 2/8/2011, 6:26 p.m.

And years ago she prepared her own living will and other health care directives, giving copies to her daughter, Cheryl, as soon as she was grown.

“Remembering my mother, we had the discussion,” says Moore.

It’s not clear how often the still healthy like Moore do that kind of advance planning.

But the oncology society says it isn’t happening enough with the very sick. Fewer than 40 percent of advanced cancer patients have what it calls a “realistic conversation” with their doctors about what to expect and their choices of care.

The consequences: Patients increasingly are receiving aggressive chemotherapy in the last two weeks of life. They are spending more of their last months hospitalized. They’re not told that a lot of expensive, side effect-prone therapies buy at best a few more months.

They think palliative care - specialized care for pain, nausea, shortness of breath - means giving up when it should be offered with standard anti-tumor care.

And they are not referred to hospice until their final days. Lichter tells of a lung cancer patient who spent his last days on a ventilator, unable to say goodbye and incurring $25,000 in hospital bills, because his family called 911 when he became short of breath. Hospice care could have eased that symptom at home.

The society plans by summer to issue detailed guidelines to help doctors conduct those tough conversations. Meanwhile, among its advice for patients:

- Ask your doctor about pros and cons of different treatment options, and discuss your priorities, including quality of life, with the doctor and family. You can change your mind later.

- Ask about palliative care for symptom relief along with your chemo. A major study last summer found that combination helped advanced lung cancer patients live a few months longer, because people who feel better can tolerate more anti-cancer treatment.

- A living will ensures health workers and family know your choices when you cannot communicate, including whether you would want such things as a feeding tube.

- Most clinical trials for experimental treatments won’t admit people who’ve already undergone multiple treatments, so consider that option early.

Associated Press