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EMBARGOED FOR RELEASE 1:30 P.M. (MDT), Sunday, May 18, 1997
LEADING CANCER SPECIALISTS HOLD FRANK DISCUSSION ON END-OF-LIFE CARE
-- Special ASCO Forum Debates Physician-Assisted Suicide; Confronts Inadequate Pain Management, High Cost of Care --
Denver, CO -- Amid a contentious national debate over physician-assisted suicide, and an increased reliance on life-prolonging technology, the worldÃs leading cancer specialists today confronted some of the most controversial issues surrounding end-of-life care of cancer patients at a major session of the Thirty-third Annual Meeting of the American Society of Clinical Oncology. ASCO has taken a leadership role in addressing end-of-life issues in the oncology field, and has established a special task force to help improve professional care of the terminally ill.
ìIf we hope to provide the highest quality care and treatment for cancer patients, we must openly, unabashedly address some of the most controversial issues we face -- physician-assisted suicide, inadequate palliative care, prolonged hospital stays, and the skyrocketing cost of treatment for the terminally ill,î said Robert J. Mayer, MD, ASCOÃs incoming president, who has announced that improving end-of-life care will be a major focus of his tenure.
ìDignified, supportive, pain-free care is unequivocally what we want for our patients and ourselves. Unfortunately, the facts are quite different,î said session co-chair Diane Blum, MSW, Executive Director of Cancer Care, Inc., a non-profit organization that provides support and education to cancer patients and their families. ìWe must involve everyone -- patients, physicians, and families -- in a concerted effort to improve the care of the dying, and incorporate that care into the continuum of high quality treatment.î
ASCO asked some of the worldÃs leading experts in the field to participate in the discussion, held at the societyÃs Annual Meeting, which is attended by more than 14,000 cancer clinicians and researchers. Among the speakers were Marcia Angell, MD, Executive Editor of The New England Journal of Medicine, a leading advocate of the legalization of physician-assisted suicide, and Kathleen Foley, MD, Co-Chief of Pain and Palliative Care Service at the Memorial Sloan-Kettering Cancer Center, a strong opponent of assisted suicide. The two published provocative opposing editorials on the topic in The New England Journal of Medicine earlier this year.
Dr. Angell maintains that end-of-life care should focus attention on the autonomy and the desires of the patient, not the physician, and that the overriding duty of physicians is to relieve suffering and respect their patientsà autonomy. Dr. Foley argues that the nation should not consider the legalization of physician-assisted suicide until it has seriously and adequately addressed the needs of its citizens for pain relief and palliative care.
The debate echoes the controversy within the medical community and the general public, with surveys in Michigan and Oregon showing that roughly two-thirds of Americans support the legalization of physician-assisted suicide, as do more than half of doctors, while a survey of Canadians found less support among both the general public and physicians. A survey of Washington doctors found that one in four had been asked to help a patient die, and that the request was granted in 25% of the cases.
Other speakers included Dr. Thomas Smith of the Massey Cancer Center, who has conducted extensive research on the cost of end-of-life care and the implications for the efficient allocation of health care dollars. Smith cites the skyrocketing cost of cancer care -- from $35 billion to more than $50 billion in the last six years, a figure that is expected to continue to increase as the population ages. With 10% of people consuming 75% of all health care resources, and one-quarter of all hospital costs in the U.S. going to care for patients in the nationÃs 78,000 intensive-care beds -- many of them terminally ill -- Smith questions the value of devoting disproportionate resources to the terminally ill. He argues for the drastic improvement of alternative, cost-saving forms of palliative care, such as hospice care, and for the appropriate use of managed care to control costs while maintaining quality.
Declan Walsh, MSc, FACP, Director of the Palliative Care Program in the Cancer Center of the Cleveland Clinic Foundation, cites the severe lack of palliative care programs and education at medical schools, in textbooks, and at comprehensive cancer centers, and criticizes funding agencies for ignoring the need of cancer patients for palliative relief. Walsh discusses models of effective palliative care, citing the Cleveland Clinic program and the principles and practices of St. ChristopherÃs Hospice in London. Hospice care is discussed as an increasingly viable option for patients nearing the end of life, providing increased comfort in a more home-like environment. There are currently 2,700 hospice organizations in the United States.
The view outside the contentious U.S. debate is presented by Dr. Sam Ahmedzai at the University of Sheffield in England. Dr. Ahmedzai discusses the diverse cultural attitudes toward disease and end of life throughout Europe, with some countries openly addressing euthanasia, while in others, candid discussion of terminal illness may be avoided altogether. He cautions against seeking a universal approach to managing end-of-life care, and stresses the importance of considering individual and cultural values.
The discussion comes amid surveys showing that physicians are rarely aware of their patientsà end-of-life wishes -- such as do-not-resuscitate orders and living wills, that many Americans do not make adequate plans for care at the end of life, and that most people in the U.S. die in hospitals and nursing homes, despite surveys showing that the vast majority of people say they would prefer to die at home.
ìASCO is committed to addressing end-of-life issues that have received inadequate attention -- determining the site of terminal care, formalizing interactions with hospice organizations, improving palliative care and patient communication, and providing continuity of care to patients and their families from diagnosis to death,î said Dr. Mayer.
ASCO has established a subcommittee on Cancer Care at the End of Life, which is charged with developing an official ASCO opinion paper on the topic, establishing educational initiatives for health care professionals, and undertaking a survey of ASCOÃs membership to assess how oncologists address end of life issues in caring for their patients. In 1992, ASCO published ìCancer Pain Assessment and Treatment Curriculum Guidelinesî and in 1993 sponsored a national conference on cancer-related pain.
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