Managing End-of-Life Care for Patients with Advanced Otolaryngic Cancers

Understanding preexisting attitudes of patients and their caregivers regarding quality of life versus quantity of life may help otolaryngologists determine how to better use healthcare resources for end-of-life care.

This conclusion came from a recent study that examined the preexisting attitudes of patients, caregivers, and otolaryngologists that influence decisions regarding end-of-life resource allocation. The researchers found that patients with cancer and their caregivers have preferences that differ from otolaryngologists when it comes to end-of-life care.

“Preexisting attitudes on quality versus quantity made generally no difference in how physicians allocated palliative care and level of cancer treatment, while preexisting attitudes in patient and caregivers significantly impacted these allocations in palliative care and level of cancer treatment,” said senior author Walter T. Lee, MD, co-director of the Head and Neck Program at Duke Cancer Institute in Durham, N.C.

In the study, data on baseline attitudes toward quality versus quantity of life were collected from 767 participating otolaryngologists, 146 patients with advanced cancer, and 114 caregivers. The study found that end-of-life decision making by cancer patients and their caregivers was significantly affected by quality of life and a preference for resource allocation to palliative care and other medical care versus treatment for cancer.

For otolaryngologists, however, end-of-life decision making was not influenced by preexisting attitudes. According to Dr. Lee, these results suggest that otolaryngologists should take time to understand patient attitudes to help allocate resources at end of life that are congruent with the patient wishes.

“These conversations can occur over multiple visits with patients and their caregivers,” he said, adding that otolaryngologists should get to know and understand the resources available at their medical centers, such as family counseling and social workers, to assist patients and their families with end-of-life decisions.