June 2002

Dear Readers: Here's the Article for this Month:

Name of article:

Attitudes of terminally ill cancer patients about euthanasia and assisted suicide: predominance of psychosocial determinants and beliefs over symptom distress and subsequent survival.

Author(s): Suarez-Almazor ME, Newman C, Hanson J, Bruera E.

Reference: J Clin Oncol 2002; 20: 2134-41

Abstract:

The aim of this survey was to evaluate whether the attitudes regarding euthanasia and PAS of terminally ill cancer patients were related to the severity of their disease as determined by their symptoms, and their subsequent survival.

100 patients with terminal cancer (locally advanced or metastatic disease non responsive to oncological treatment) and adequate cognition (defined as a mini-mental status score of 24 or higher) who completed a symptomatic evaluation by means of the Edmonton Symptom Assessment Scale (ESAS) were interviewed.

All patients were cared for by palliative care teams of the the Palliative Care Regional Program in Edmonton, Canada. The 17% of the patients were receiving outpatient care and 83% were receiving inpatient care.

The interview was carried out by research nurses from the palliative care unit not involved in the clinical care of the patients and included 4 items (i.e. affermative statements) concerning attitudes regarding euthanasia and PAS in relation to a terminal cancer patient, 2 items concerning attitudes to themselves and 3 items regarding general belief about suffering and burden to families. Two questions were about the presence and frequency of suicidal ideation of the patients under study in the previous month. Additional questions gave information on sociodemographic variables including education, religion, strength of religious beliefs.

69% supported euthanasia or PAS for one or more situations. The significant determinants of euthanasia and PAS attitudes were men sex, lack of religious belief and general belief about the suffering of cancer patients and their families Dyspnea was the only symptom statistically associated with agreement across most items whereas tiredness and anxiety were statistically associated only with selected items.

80% of patients perceived that patients with cancer were a heavy burden to their families; however these beliefs were not consistently associated with the patients’ current symptom intensity.

Statistically associations included depression with emotional and physical suffering, anxiety with physical suffering, appetite with burden to families.

Regarding the frequency of suicidal ideation 69 patients responded never, 25 rarely/sometimes, 5 often and one all the time. Frequency of suicidal ideation was significantly associated with depression, anxiety, poor-well-being and dyspnea.

Why I chose this Article:

Discussion regarding euthanasia and PAS in cancer patients continues to be an important topical subject on medical, ethical, religious, political and legislative grounds.

The conclusion of this study is to be added to other studies carried out on terminally ill cancer patients (Chochinov HM et al. Lancet 1999; Emanuel EJ Lancet 1996) indicating that patients’ attitudes about legalization of euthanasia and PAS are mainly associated to psychological traits, religious beliefs and general views about suffering in cancer patients and not associated to the severity of symptoms.

Regards,

Carla Ripamonti, MD
Member of the Board of Directors, IAHPC