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End-of-Life Care for Terminal Head and Neck Cancer Patients

Sesterhenn, Andreas M. MD, PhD; Folz, Benedikt J. MD, PhD; Bieker, Michael MD; Teymoortash, Afshin MD, PhD; Werner, Jochen A. MD, PhD

doi: 10.1097/01.NCC.0000305709.37530.a7
Articles

The objective of this study was to describe end-stage disease in patients suffering from advanced head and neck cancer (hnc). It is one of the most unpleasant and agonizing way a person may die and is a challenging problem for all involved with its treatment. Until today, only few detailed information about the final phase of life of hnc patients in a hospice setting are available. The design of this study was a cohort sample. The course of disease until death was thoroughly analyzed. In addition, hospice staff was interviewed. The study was conducted in a hospice setting (University Hospital). The charts of 16 patients suffering from end-stage hnc were evaluated. The median survival time in the hospice was 19.5 days. There, a more or less rapid deterioration of disease was evident. Several nurses sometimes felt extremely distressed after confrontation with the advanced disease stages. Partially, the situations for the nursing staff were unbearable because of visible, odorous, and fungating tumors or metastasis. The final days were characterized by restlessness followed by somnolence and resulting in an irreversible coma. The goal of palliative treatment of terminal hnc patients is offering the most convenient way to "live" the final days of their lives in dignity. The short survival time in hospice indicates that incurable patients may be referred to terminal care institutions too late in their dying trajectory. Physicians should be encouraged to talk to their terminally ill patients about the status and incurability of the disease as early as possible to facilitate patient and family decision making on how to prepare for the impending end of life.

The objective of this study was to describe end-stage disease in patients suffering from advanced head and neck cancer (hnc). It is one of the most unpleasant and agonizing way a person may die and is a challenging problem for all involved with its treatment. Until today, only few detailed information about the final phase of life of hnc patients in a hospice setting are available. The design of this study was a cohort sample. The course of disease until death was thoroughly analyzed. In addition, hospice staff was interviewed. The study was conducted in a hospice setting (University Hospital). The charts of 16 patients suffering from end-stage hnc were evaluated. The median survival time in the hospice was 19.5 days. There, a more or less rapid deterioration of disease was evident. Several nurses sometimes felt extremely distressed after confrontation with the advanced disease stages. Partially, the situations for the nursing staff were unbearable because of visible, odorous, and fungating tumors or metastasis. The final days were characterized by restlessness followed by somnolence and resulting in an irreversible coma. The goal of palliative treatment of terminal hnc patients is offering the most convenient way to "live" the final days of their lives in dignity. The short survival time in hospice indicates that incurable patients may be referred to terminal care institutions too late in their dying trajectory. Physicians should be encouraged to talk to their terminally ill patients about the status and incurability of the disease as early as possible to facilitate patient and family decision making on how to prepare for the impending end of life.

Authors' Affiliations: Department of Otolaryngology, Head & Neck Surgery (Drs Sesterhenn, Folz, and Teymoortash and Ms Werner) and Department of Radiation Oncology (Dr Bieker), Philipps-University of Marburg, Germany.

Corresponding author: Andreas M. Sesterhenn, MD, PhD, Department of Otolaryngology, Head & Neck Surgery, University of Marburg, Deutschhausstr. 3, D-35037 Marburg, Germany (sesterhenn@hno-marburg.de).

Accepted for publication October 5, 2007.

© 2008 Lippincott Williams & Wilkins, Inc.