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End-of-Life Choices

71563809_47If your initial diagnosis was for advanced (stage IV) head and neck cancer, your likelihood of survival within five years is low; out of patients similarly diagnosed with advanced head and neck cancer, 65 percent were deceased within five years.1 Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations). National Cancer Institute. Bethesda, MD.Accessed at http://seer.cancer.gov/csr/1975_2009_pops09/, based on November 2011 SEER data submission, posted to the SEER web site, 2012. Although this may not be hopeful for you, awareness of this information should enable you to begin making your end-of-life choices.

You may want to reflect upon a few questions so that you can make end-of-life decisions:

  • What type of medical care do you desire at the end of your life? For example, do you want to receive CPR if you have a year or less to live? You may want to put legal documents into place, such as assigning a medical power of attorney to make these decisions for you.
  • Where do you want to die and how do you want to die? You may want to review hospice policies and decide which hospices may or may not be appropriate for you.

If possible, you may want to think about your options for the end of life, but periodically revisit your decisions. A few studies of patients who receive in-hospital treatment have found that patients change their opinion of various types of medical treatments, especially before and after hospitalizations.2, Lockhart LK, Ditto PH, Danks JH, Coppola KM, Smucker WD. The stability of older adults' judgments of fates better and worse than death. Death Stud. 2001 Jun;25(4):299-317.3 Ditto PH, Jacobson JA, Smucker WD, Danks JH, Fagerlin A. Context changes choices: a prospective study of the effects of hospitalization on life-sustaining treatment preferences. Med Decis Making. 2006 Jul-Aug;26(4):313-22.


References

1 Howlader N, Noone AM, Krapcho M, et al. SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations). National Cancer Institute. Bethesda, MD.Accessed at http://seer.cancer.gov/csr/1975_2009_pops09/, based on November 2011 SEER data submission, posted to the SEER web site, 2012.

2 Lockhart LK, Ditto PH, Danks JH, Coppola KM, Smucker WD. The stability of older adults' judgments of fates better and worse than death. Death Stud. 2001 Jun;25(4):299-317.

3 Ditto PH, Jacobson JA, Smucker WD, Danks JH, Fagerlin A. Context changes choices: a prospective study of the effects of hospitalization on life-sustaining treatment preferences. Med Decis Making. 2006 Jul-Aug;26(4):313-22.

4 Messinger-Rapport BJ, Baum EE, Smith ML. Advance care planning: Beyond the living will. Cleve Clin J Med. 2009 May;76(5):276-85.

5 Bomba PA, Kemp M, Black JS. POLST: An improvement over traditional advance directives. Cleve Clin J Med. 2012 Jul;79(7):457-64.

6 Earle CC, Park ER, Lai B, Weeks JC, Ayanian JZ, Block S. Identifying potential indicators of the quality of end-of-life cancer care from administrative data. J Clin Oncol. 2003 Mar 15;21(6):1133-8.

7 Torpy JM, Burke A, Golub RM. Hospice care. JAMA. 2012 Jul 11;308(2):200.

8 Current Clinical Issues: The debate in hospice care. JOP. 2008;4(3):153-157.

9 Levy MH, Adolph MD, Back A, et al. Palliative care. J Natl Compr Canc Netw. 2012;10:1284-1309.