Otolaryngology Training Short on End-of-Life Care Advice

One presenter offers guidance on what otolaryngologists can do to offer comfort to their dying head and neck cancer patients

TORONTO-Otolaryngologists are generally not trained in end-of-life issues, even though they are certainly not strangers to having to work with dying patients.

In a presentation at the recent Annual Meeting of the Eastern Section of the Triological Society here, Matthew Russell, a medical student at Boston University School of Medicine (Mass.), described details ranging from predicting when end of life will occur in certain types of head and neck cancer patients to managing pain and talking to family members.

Caring for patients at the end of life is one of the most intimate interactions a physician can have. But little training is provided on these issues in subspecialty training, he said. Head and neck cancer is not always 100% curable, and is a cause of death the otolaryngologist-head and neck surgeon is close to. While physicians have little training in the realm of helping the dying patient, it’s not something to be shunned, he said. It is an important time to offer comfort and reassurances to patients, find ways to help reduce their pain, and make their transition to end of life easier.

Understanding mechanisms of death, reasonably prognosticating residual time of life, and understanding cultural context for patients can relieve much of the anxiety experienced in these difficult times, Russell said.

For nociceptive pain resulting from bone metastases, opioids aren’t enough and the patient needs to be treated with radiation therapy.

Issues to Consider

Terminal otolaryngic patients can suffer from hunger, pain, dyspnea, nausea, vomiting, diarrhea, and delirium. Appropriate management can help patients and families feel less distress through the terminal events, he said.

Much is known about the behavior and patterns of head and neck malignancy. As a consequence, the pattern of metastatic spread of the major head and neck tumors is relatively predictive of symptoms that each cancer type can produce-meaning when the end of life will come and which symptoms are likely to be present are fairly predictable. The information can be used by the physician to guide treatment, as well as to counsel patients.

Caring for patients at the end of life is one of the most intimate interactions a physician can have. But little training is provided on these issues in subspecialty training. – -Matthew Russell

Predictive markers for end of life occurring within two weeks include Cheyne Stokes respiration (changes in respiration patterns, including episodes of apnea), along with the patient being in bed greater than 90% of the time.