Not all conditions should be treated at end of life, study suggests
March 23, 2015 | by Tami Dennis
Just because you can treat a condition, such as high cholesterol, at the end of life — well, that doesn't mean you should. That's the basic lesson of a study to be published March 30 in JAMA Internal Medicine. The ramifications go far beyond that.
The research, in which City of Hope's Betty Ferrell, Ph.D., R.N., participated, found that stopping the use of statins in patients with late-stage cancer and other terminal illnesses can actually improve quality of life, without doing harm to the patient. That's no small finding. Statins are one of the most commonly prescribed medications in the United States, as the press release about the study points out, and many patients for whom cure is no longer an option will be affected if doctors take the lesson to heart.
To summarize: The study on end-of-life care involved 381 patients — with a mean age of 74.1 years — about half of whom continued their cholesterol medication and about half of whom stopped. More than a fifth were cognitively impaired, and almost half had cancer. The researchers found that the number of study participants who died within 60 days was about the same for both the statin-taking and statin-forgoing groups but, of special significance, the quality of life was better for those who stopped taking statins.
“If the results we report – improved quality of life, no significant differences in mortality and modest cost savings — had been produced by a randomized clinical trial of a new drug in patients with advanced life-limiting illness, the trial would be heralded as a breakthrough and there would be discussion of how to speed access to this new drug,” the authors write. “The same energy needs to be applied to determining when it is appropriate for physicians to discuss discontinuing statin therapy with their patients.”
The results, released online March 23 ahead of print in JAMA Internal Medicine, suggest that care for patients at the end of life can actually be improved with a much-needed adjustment of priorities — in other words, a reality and priority check.
"This study is a first important example of how we can balance what patients need — and what care is no longer helpful at the end of life," said Ferrell. "This is a very significant contribution to advancing our understanding of caring for people with advanced diseases and those at the end of life."
City of Hope, and Ferrell herself, have been instrumental in improving care for patients at the end of life. City of Hope was prominent in the formation of the End-of-life Nursing Education Consortium, which teaches nurses and other health care professionals how to address patients' needs at the end of life. As for Ferrell, the American Academy of Hospice and Palliative Medicine has named her one of the 30 most influential leaders in hospice and palliative care medicine.
"For patients and families, quality of life is important," she said. "We need systems of care that provide the greatest support for patients and for their family caregivers."
This study will support that extremely important goal.
Learn more about becoming a patient or getting a second opinion by visiting our website or by calling 800-826-HOPE (4673). You may also request a new patient appointment online. City of Hope staff will explain what's required for a consult at City of Hope and help you determine, before you come in, whether or not your insurance will pay for the appointment.