Opinion

Photo from Rebecca Shatsky/X

Apr 2, 2024, 20:06

Rebecca Shatsky: Living in the hospital is not beneficial for patients with end stage cancer

Rebecca Shatsky recently posted on X:

“Attending on the inpatient oncology consult service is such a harrowing experience. It reinforces to me every time I do it that humans with end stage cancer should not spend the end of their life in the hospital

To my physician and patient community followers, please hear me. There are still limits to what medicine can and ethically should do. If someone cannot eat and is too weak to get out of bed due to heavily pretreated advanced cancer living in the hospital is not beneficial.

Intubation and CPR and total parentenal (aka IV nutrition) are not beneficial interventions for patients with end stage cancer.

There is a HUGE difference between someone who is super sick due to a NEW diagnosis of untreated cancer and those that are incredibly sick because they have cancer refractory to prior therapies.

Oncology colleagues, I beg you to look at the patient in front of you and decide whether it is going to really be beneficial to pursue additional cancer therapy. If the cancer treatment u are providing has little to no chance of leading to person being able to leave the hospital then maybe it is not appropriate.

Have discussions with your patients about how sick they are and what options are at the end of life and what interventions will be beneficial and what will not BEFORE your patients get this sick.

I take care of a huge population of patients with advanced cancer, but almost never have one of my own patients die in the hospital and especially not in the ICU. The end of life should be spent with family in comfort. Not with tubes in every organ after months in the hospital.

Finally, family members of dying patients, please do not pressure your loved ones into aggressive treatment that their doctors do not recommend. I see this so often. Family feel like they are helping by saying “do everything!” Yet this causes so much unnecessary suffering.”

Source: Rebecca Shatsky/X

Rebecca Shatsky is an Associate Professor at UC San Diego Health, Breast Medical Oncology Co-Team Leader, Scientific Director of the Inflammatory and Triple Negative Breast Cancer Program. She is a member of the NCCN guideline panel for Genetic/High-Risk Assessment of Breast, Ovarian, and Pancreatic Cancer and the panel for the treatment of Cancer-Associated Pain. Her work has been published in JAMA Oncology, Cancer Cell, and Molecular Cancer Therapeutics, among others. Dr. Shatsky is a member of the American Association for Cancer Research and the American Society of Clinical Oncology.