Impact of Awareness of Terminal Illness and Use of Palliative Care or Intensive Care Unit on the Survival of Terminally Ill Patients With Cancer: Prospective Cohort Study
Menée en Corée auprès de 619 patients atteints de cancer, cette étude évalue l’association entre leur conscience d’être en phase terminale de la maladie et leur recours aux soins palliatifs
Purpose We conducted this study to evaluate the validity of the perception that awareness of their terminal prognosisuse of palliative care or nonuse of an intensive care unit (ICU) causes patients to die sooner than they would otherwise.Patients and Methods In this prospective cohort study at 11 university hospitalsthe National Cancer Center in Korea, we administered questionnaires to 619 consecutive patients immediately after they were determined by physicians to be terminally ill. We followed patients during 6 months after enrollmentassessed how their survival was affected by the disclosure of terminal illnessadministration of palliative care or nonuse of the ICU.Results In a follow-up of 481 patients163.8 person-years, we identified 466 deceased patients. Nineteen percent of the patients died within 1 month, while 41.3% lived for 3 months,17.7% lived for 6 months. Once the cancer was judged terminal, the median survival time was 69 days. On multivariate analysis, neither patient awareness of terminal status at baseline (adjusted hazard ratio [aHR], 1.20; 95% CI, 0.96 to 1.51), use of a palliative care facility (aHR, 0.96; 95% CI, 0.76 to 1.21), nor general prostration (aHR, 1.23; 95% CI, 0.96 to 1.57) was associated with reduced survival. Use of the ICU (aHR, 1.47; 95% CI, 1.06 to 2.05)poor Eastern Cooperative Oncology Group performance status (aHR, 1.37; 95% CI, 1.10 to 1.71) were significantly associated with poor survival.Conclusion Patients' being aware that they are dyingentering a palliative care facility or ICU does not seem to influence patients' survival.