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Cancer patients, doctors don't know when to give up

By ASSOCIATED PRESS
Published June 3, 2006

ATLANTA - Doctors are reporting a disturbing rise in the number of cancer patients getting chemo and other aggressive but futile treatment in the last days of their lives.

Critics of the practice say doctors should be concentrating instead on helping these patients die with dignity and in comfort, perhaps in a hospice.

Nearly 12 percent of cancer patients who died in 1999 received chemotherapy in the last two weeks of life, according to a review of Medicare records. That is up from nearly 10 percent in 1993, and the percentage probably is higher today, researchers said.

"Patients don't like to give up," and neither do physicians, said Dr. Roy Herbst, a cancer specialist at the University of Texas' M.D. Anderson Cancer Center in Houston who had no role in the study.

Overly aggressive treatment gives false hope and puts people through grueling and costly ordeals when there is no chance of a cure, cancer specialists said.

"There is a time to stop," said Dr. Craig Earle of the Dana-Farber Cancer Institute and Harvard Medical School. "It's sometimes easier to just keep giving chemotherapy than to have a frank discussion about hospice and palliative care."

Earle led the federally funded study and presented the findings Friday at a meeting in Atlanta of the American Society of Clinical Oncology.

He examined Medicare records on the care of 215,488 people who died of cancer in the 1990s.

Admissions to hospital intensive care units in the last month of life climbed from nearly 8 percent in 1993 to 11 percent in 1999. Emergency room visits rose from about 24 percent to more than 28 percent.

The number of cancer patients entering hospice in the last three days of life also rose, from roughly 12 percent to 15 percent.

"That's like a waste of the whole hospice process," which stresses preparing the patient emotionally and physically for death, Herbst said. "People have to be ready to do that."

Part of the problem is that doctors cannot predict how soon an individual patient will die, even when they know the cancer has spread widely and is incurable.

This study focused on traditional chemotherapy and was done before newer medicines like Herceptin, Avastin and Gleevec, which more precisely target cancer, came into wide use.

However, another study presented at the cancer meeting on Friday showed the opposite problem: people not getting enough care.

A survey of nearly 700 primary care doctors in Wisconsin found that only 11 percent would refer a patient with advanced lung cancer to a cancer specialist and only 25 percent would refer a woman with advanced breast cancer.

"We also found a general lack of knowledge about the benefits of newer treatments" that can help such patients, said Dr. Timothy Wassenaar of the University of Wisconsin-Madison, who reported on the study at the cancer meeting.

"That's horrible," Herbst said of the unwillingness to refer such patients. He said newer chemotherapy treatments have extended lung cancer survival from 20 percent at one year to nearly 50 percent now.

[Last modified June 3, 2006, 06:28:28]