Chemotherapy as a treatment for cancer has saved millions of lives, but it is notorious for its horrendous side effects. While the method that you choose to fight cancer is a highly personal decision, it’s interesting to note that most doctors choose not to undergo chemotherapy towards the end of their own lives, as reported in a 2014 study. [1]

“Our study raises questions about why doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life”, researchers say.

Rising Cancer Rates In America

chemotherapy

General health awareness within the public, along with modern technology, have made it possible for people to live longer than the people of past generations. With that longevity comes a greater need for medical care.

In 2005, 133 million Americans, almost 50% of the population, had at least one chronic illness[3]. Cancer, in particular, is among the leading causes of death worldwide, with 1,685,210 new cases in the United States in 2016 alone [5]. It is said that National expenditures for cancer care in the United States will reach $156 billion in 2020[5]. With so many Americans getting sick, the need for medical assistance has been growing.

A Dartmouth Atlas Report shows that nationally there has been an increase in Medicare beneficiaries that saw more than ten different physicians in their last six months of life, and spent more days in intensive care units in 2010 compared to 2003-2007[4].

However, many people prefer to pass away peacefully, surrounded by friends and family. So, in a time where more than 80% of patients say that they wish to avoid hospitalization and high-intensity care at the end of their life[2] why, then, are doctors insisting on such invasive treatments?

Doctors Choose NOT to Participate in Treatment that they Prescribe to Patients

An interesting study found that doctors opt out of chemotherapy treatment towards the ends of their own lives, despite recommending it to their patients throughout the course of their medical career.

The study was conducted twice, once in 1989 and once again in 2013, following a number of unrelated doctors in America, and they found that the result was similar for each group despite the difference in decades.

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The researchers found that 88.3% of doctors from the 2013 study wished to forego high-intensive treatment for themselves at the end of their lives[1]. It also showed that doctors who specialized in Emergency Medicine, PM&R, Pediatrics, Obstetrics & Gynecology and Anesthesia thought more positively about high-intensity treatment than doctors whose specialties were in Surgery, Orthopedics and Radiation Oncology[1].

“The majority of the 2013 doctors opted for the Do-Not-Prolong Life (no-code status) for themselves when terminally ill. Only 11.7% of the doctors opted for the Choice-to-Prolong Life (full-code status) for themselves[1]” the researchers report.

Doctors who were less supportive of a high-intensity end of life treatment were more likely to choose full-code status (or the choice-to-prolong life), and less likely to opt-in for organ donation[1].

Due to the similarities between the 1989 and 2013 study, we can see that doctors opinions on the matter have changed little in the 23-year time difference, despite the further medical knowledge and technology that has developed within that time.  

The researchers who conducted the study hypothesized as to why the doctors may feel this way, and their opinions are striking.

The Reasons a Doctor May be Opposed to Chemotherapy Treatment

After discovering the results for their study, the researchers made several educated inquiries as to why such a high percentage of doctors are choosing to forego chemotherapy for themselves, while still offering it to patients.

  1. They witness a lot of pain in their career

Throughout the course of their careers, doctors experience many highs and lows with their patients. It’s possible that after witnessing the ongoing suffering of patients who opt into high-intensity procedures at the end of their life the doctors they choose to forego the same suffering themselves.

2. They are overly optimistic

Doctors tend to be highly optimistic about their patients and may overestimate the lifespan of their patients. This optimism can lead to an escalation of treatment until it is clear to all parties that the patient is dying. Thus, the patient’s end-of-life experience is filled with the side effects of treatment when it could instead be spent peacefully with family members.

Typically it’s comforting to have a doctor cheering for a patient on the road to recovery, but it’s not beneficial if they’re blind to the needs and wishes of the patient.

3. Culture of setting maximum intervention with patients

In the medical system currently there remains the mentality of maximum intervention, regardless of the effectiveness of doing so. While it’s considered a great asset to have a doctor that’s willing to fight to heal a patient, it becomes a problem when the doctor overrides the patient’s wishes in favor of what they believe will benefit the patient.

4. Doctors rewarded highly for high-intensity treatment

The terrible truth of the matter is that the current system rewards hospitals and doctors for high-intensity treatments and procedures. Currently, a quarter of the total Medicare budget is spent on services to beneficiaries in their last year of life, and 40% of that is on the patient within the last 30 days of their lives[1].

If the doctors themselves don’t stand behind their methods of treatment, then clearly something needs to change in the medical system.

Something Needs to Change In the Medical System

When a medical student becomes a doctor they’re often required to take a Hippocratic Oath. One of the premises within that oath is to “First, do no harm”. With regards to end-of-life treatment, the doctor may not be doing any harm, but pushing a high-intensity treatment on a patient that would rather spend his, or her, last moments peacefully may be doing just that.

Ultimately, the patient’s needs and values should be respected above all else. Greater care needs to be put into the wishes of the patient in his or her last moments.

“Policy changes are required that promote, institutionalize and reward care practices that incorporate advance care planning and early palliative care for all seriously ill persons. A flexible range of options, tailored to the local institutional culture and the individual patient’s preferences, should be available in the early provision of palliative care services,” writes the researchers that conducted the study[1].

Choose the Right Option for Yourself

Thinking about you, or your loved one’s end of life can be heartbreaking. Hopefully, this is not something that you need to think of anytime soon, but if it is, spend some time considering your own wishes and desires and communicate them with your doctor.

Remember, with regards to medical treatment, there is no black and white answer. Each individual is different, requires different treatment, and responds to that treatment differently. Ultimately it’s important to assess what is best for you and your family when making a decision. Most importantly, please keep in mind that this study reflected the doctor’s opinion of chemotherapy treatment at the end of life and does not reflect their thoughts on the treatment during an earlier stage of cancer.

When deducing the best end-of-life treatment method, whether it be high-intensity intervention or a gentle method, do as much research as possible and ask many questions to deduce the best option for you and your family.

 

SOURCES:

[1] Vyjeyanthi S. Periyakoil, Eric Neri, Ann Fond, Helena Kraemer. (2014, May 28). Do Unto Others: Doctor’s Personal End-of-Life Resuscitation Preferences and Their Attitudes Towards Advance Directives. Retrieved from http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0098246#s4

[2] The Dartmouth Atlas of Health Care website: Available http://www.dartmouthatlas.org/data/topic/topic.aspx?cat=18.Accessed 2013 Oct 1.

[3] Wu SY, Green A (2000) Projection of chronic illness prevalence and cost inflation. Santa Monica, CA: RAND Health;.

[4] http://www.dartmouthatlas.org/downloads/reports/EOL_Trend_Report_0411.pdf

[5] https://www.cancer.gov/about-cancer/understanding/statistics

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