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CC BY 4.0 · Brazilian Journal of Oncology 2020; 16: e-20200006
DOI: 10.5935/2526-8732.20200006
Original Article
Clinical Oncology

The discontinuation of antitumor treatment and the advance directives in cancer patients

A interrupção do tratamento antitumoral e as diretivas antecipadas em pacientes com câncer

Autoren

  • Pedro Grachinski Buiar 

    1   Instituto Sul Paranaense de Oncologia, Oncologia Clínica - Ponta Grossa - Paraná - Brazil

  • Jose Roberto Goldim

    2   Hospital de Clínicas de Porto Alegre, Bioethics - Porto Alegre - Rio Grande do Sul - Brazil

  • Vania Naomi Hirakata

    3   Hospital de Clínicas de Porto Alegre, Biostatistics - Porto Alegre - Rio Grande do Sul - Brazil

Financial support : none to declare.
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ABSTRACT

Objectives: Advance directives (AD) are one of the main pillars of patients' autonomy and can impact directly the quality of life, dignity and rights of the dying patient. Despitethis, advance directives face many barriers to be created, implemented and followed. The moment of discontinuation of active anticancer therapy is an important landmark in the palliative evolution of cancer patients. The aim of this study is to investigate if the discontinuation of antitumor treatment could influence rates of advance directives. Methods: A single-center retrospective case-notes review study with 321 randomly selected patients of a Single Brazilian tertiary oncology center. Qualitative and quantitative data were collected and analyzed to compare two groups of patients, one group with advance directives registered and another group without directives. Results: The rate of advance directives was 22.7%, and in 82.3% of subjects, the decision of treatment discontinuation occurs on the same day or before the AD manifestation. In multivariable analysis, 82.5% of patients with advance directives were in the doctor's office at the occasion of the discontinuation of their anticancer therapy compared with 64.4% of the patients without directives (RR 1.88; 95%CI 1.019-3.496). The most cited “living will” was the desire “to die at home” (30%), and 10% of those manifesting this directive actually died at home. Conclusion: The discontinuation of antitumor treatment may be a window for end of life and advance care plan discussions, raising the rates of advance directives. Doctor's office is a better place than emergency rooms, wards and intensive care units for the discussion about end of life aspects and advance directives.

RESUMO

Objetivos: As diretivas antecipadas (DA) são um dos principais pilares da autonomia dos pacientes e podem afetar diretamente a qualidade de vida, a dignidade e os direitos do paciente que está morrendo. Apesar disso, as diretivas antecipadas enfrentam muitas barreiras a serem criadas, implementadas e seguidas. O momento da descontinuação da terapia anticâncer ativa é um marco importante na evolução paliativa de pacientes com câncer. O objetivo deste estudo é investigar se a descontinuação do tratamento antitumoral poderia influenciar as taxas de diretivas antecipadas. Métodos: Estudo retrospectivo de notas de caso em um único centro com 321 pacientes selecionados aleatoriamente em um centro de oncologia terciária único brasileiro. Dados qualitativos e quantitativos foram coletados e analisados para comparar dois grupos de pacientes, um grupo com diretivas antecipadas registradas e outro sem diretivas. Resultados: A taxa de diretivas antecipadas foi de 22,7% e, em 82,3% dos indivíduos, a decisão de descontinuação do tratamento ocorre no mesmo dia ou antes da manifestação da DA. Na análise multivariável, 82,5% dos pacientes com diretivas antecipadas estavam no consultório no momento da descontinuação da terapia anticâncer, em comparação com 64,4% dos pacientes sem diretrizes (RR 1,88; IC95% 1,019-3,496). A “declaração de vontade” mais citada foi o desejo de “morrer em casa” (30%) e 10% dos manifestantes dessa diretiva morreram em casa. Conclusão: A descontinuação do tratamento antitumoral pode ser uma janela para discussões sobre o fim da vida e os planos de cuidados avançados, aumentando as taxas de diretivas antecipadas. O consultório médico é um lugar melhor do que as salas de emergência, enfermarias e unidades de terapia intensiva para a discussão sobre aspectos do fim da vida e diretivas antecipadas.

Keywords:

Advance directives - Medical oncology - Palliative care - Living wills

Descritores:

Diretivas antecipadas - Oncologia médica - Cuidado paliativo - Declaração de vontade

AUTHOR'S CONTRIBUTION

Pedro Grachinski Buiar: Collection and assembly of data, Conception and design, Data analysis and interpretation, Final approval of manuscript, Manuscript writing, Provision of study materials or patient.

Jose Roberto Goldim: Data analysis and interpretation, Final approval of manuscript, Manuscript writing.

Vania Naomi Hirakata: Data analysis and interpretation.




Publikationsverlauf

Eingereicht: 20. August 2019

Angenommen: 18. April 2020

Artikel online veröffentlicht:
10. Juni 2020

© 2022. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

Bibliographical Record
Pedro Grachinski Buiar, Jose Roberto Goldim, Vania Naomi Hirakata. The discontinuation of antitumor treatment and the advance directives in cancer patients. Brazilian Journal of Oncology 2020; 16: e-20200006.
DOI: 10.5935/2526-8732.20200006
 

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