NEW YORK (Reuters Health) – A desire for hastened death is uncommon among patients with metastatic cancer, despite considerable levels of pain and emotional distress, according to findings published in the June issue of the Journal of Pain and Symptom Management.
"The desire for hastened death has been associated with depression, hopelessness, physical suffering, low social support, poor spiritual well being, and low self-esteem in a number of studies of patients at the end of life," Dr. Gary Rodin, of University Health Network, Toronto, Ontario, Canada, and colleagues write. "However, the longitudinal trajectory of this phenomenon is not known, nor is it clear to what extent the desire for hastened death in such patients is a manifestation not only of suffering and demoralization but also of proximity to death."
To clarify this point, the researchers assessed the prevalence of a desire for hastened death and its correlates in a cohort of 326 ambulatory patients with metastatic gastrointestinal or lung cancer who were expected to live at least 6 months.
Of the group, 207 (63.5%) were younger than 65 years of age (median 61.9 years), 111 (34%) were within 6 months of their diagnosis, and 201 (61.7%) were receiving chemotherapy at the time of study participation. They completed a package of self-report questionnaires to measure pain, depression, hopelessness, social support, function, chronic illness, self-esteem, spiritual well-being, and attitudes toward hastened death.
Overall, 166 patients (50.9%) reported pain. Of these, 28 (16.9%) rated their pain intensity as moderate to severe. Participants reported an average of 6.9 physical symptoms. Seventy-six subjects (23.3%) reported elevated levels of depression and 75 subjects (23%) reported elevated levels of hopelessness. Only five patients (1.5%) reported a strong desire for hastened death.
The desire for hastened death was positively correlated with hopelessness, depression, and physical distress, and negatively correlated with physical functioning, spiritual well-being, social support, and self-esteem. No association was found with treatment or proximity to death.
"The will to live tends to be preserved in cancer patients prior to the end of life, in spite of significant emotional and physical suffering," Dr. Rodin’s team concludes. "Further, identifying the desire for hastened death when it first occurs may lead to opportunities for therapeutic intervention."