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Maintaining the Will to Live of Patients With Advanced Cancer

Khan, Luluel MD*; Wong, Rebecca KS, MBChB*; Li, Madeline MD, PhD; Zimmermann, Camilla MD, PhD†‡; Lo, Chris PhD; Gagliese, Lucia PhD†‡; Rodin, Gary MD†‡

doi: 10.1097/PPO.0b013e3181f45b90
Special Issue on the Role of the Oncologist in Palliative Care

The will to live is a natural instinct experienced by all human beings. It tends to persist in humans, despite marked adversity such as that associated with advanced cancer. The will to live may be measured directly, or indirectly, by assessing the desire for hastened death. Factors that may affect it include age, life stage, and physical and psychological distress. In particular, states of depression and hopelessness may precede the loss of the will to live. Other psychosocial variables that may affect the will to live include physical suffering, attachment security, self-esteem, and spiritual well-being. A number of screening tools are available to identify risk factors for the loss of the will to live. Awareness of these factors can guide interventions to preserve morale and maintain hope in patients faced with a terminal illness. Critical among these are the alleviation of physical and psychosocial distress and the establishment of a therapeutic alliance that is sensitive to the specific support needs of individual patients. Comfort and facility with such supportive interventions in oncology will require greater attention to the development of communication and relationship skills at both undergraduate and postgraduate levels of training.

From the Departments of *Radiation Oncology and †Psychosocial Oncology and Palliative Care, University Health Network; University of Toronto; ‡Ontario Cancer Institute; and §School of Kinesiology, York University, Toronto, Ontario, Canada.

Reprints: Gary Rodin, MD, Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, 16th Floor, Room 724, 610 University Ave, Toronto, Ontario, Canada M5G 2M9. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.