This article originally appeared on www.ASCO.org

The October 2017 Issue of the Journal of Oncology Practice is a Special Series that highlights end-of-life care in relation to clinical ethics in oncology. The articles included in this Issue show the progression of clinical ethics over the last 50 years and the ways physicians are working hard to provide their patients with optimal care at the end of life.

Taking care of patients and their families as they face end-of-life care decisions is an important and difficult role that oncologists serve—it is often uncomfortable and at times will reveal conflicting values and goals among the providers, patients, and their families. The October Issue addresses several specific challenges of communication near the end of life, physician-assisted dying, goals of end-of-life care, and other contemporary issues in caring for advanced cancer patients. The Special Series also features several articles that emphasize the important role of palliative care in providing comprehensive support of patients and their families at all stages of cancer care.

“We do want people to feel hopeful and to know that those of us who have taken on the task of caring for them are giving it our all, but we do not want people to feel like they lost the fight or were not strong enough when the face they reality of dying from cancer,” write Nneka Sederstrom, Thomas W. LeBlanc, and Jamie Von Roenn in the issue Foreword, Ethics Never Left. The reflections from providers included in this Issue help their peers and the public to better understand the complexities of the oncologist’s role.

Some of the studies highlighted in the Ethics in End-of-Life Care Special Series include:

• Association of Physician Orders for Life-Sustaining Treatment Form Use With End-of-Life Care Quality Metrics: Studies have suggested that patients with advanced cancer who partake in advance care planning discussion achieve a better quality of life during the end the end of life and undergo less unwanted medical care. This study similarly found that patients who completed Physician Orders for Life Sustaining Treatment (POLST) forms rather than advance directives were more likely to be associated with positive results for two metrics for quality end-of-life care: out of hospital death rate and hospice admission. The POLST forms provide the opportunity for end-of-life care discussion in which the patient’s preferences can be converted into medical orders. Those who completed the forms had a higher out of hospital death rate (85.5% v 72.0%) and higher hospice admission rate (49.9% v 27.0%) when compared to the advanced directives group representing a practical approach to improve end-of-life care.
• Patterns of Resuscitation Care and Survival After In-Hospital Cardiac Arrest in Patients With Advanced Cancer: Researchers found that the survival rate of patients with advanced cancer who have cardiac arrest in a hospital setting is about half that of patients without advanced cancer. Patients in the study with advanced cancer more frequently had “do not resuscitate” orders after their cardiac arrest than those without advanced cancer (55.6% versus 43%). Though previous research has assessed survival in advanced cancer patients, no prior study has evaluated cardiac arrest survival in a large nationwide cohort of patients. This study was a way to look at this issue on a broad scale, and its results are further strengthened by the use of a robust standardized registry.
• Pediatric-Specific End-of-Life Care Quality Measures: An Unmet Need of a Vulnerable Population: Study authors outlined how pediatric end-of-life care is conceptually and operationally different from that of adults along with ways to address gaps and challenges in care. The authors go through quality measurements of end-of-life care that require modification for pediatric patients with cancer. Some of the key differences highlighted include:
  • Structures and process of care
  • Care at the end of life
  • Physical aspects of care
  • Psychological and psychiatric aspects of care
  • Social aspects of care

By modifying these measures, providers can better meet the needs of these patients and their families. The authors advocate for the establishment of quality measure to specifically address pediatric needs.

ASCO has worked to provide physicians, patients, and others throughout the cancer community with resources and tools to ensure the delivery of high-quality care at the end-of-life to patients with cancer.

The Society has also advocated for payment models that include end of life care as part of its policy goal to advance evidence-based policies and delivery system reform that supports oncology providers in their delivery of high quality, high value cancer care.  Read the full issueand ASCO’s full range of resources on this issue.

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