Though there have been significant improvements in the treatment of head and neck cancer, there is still a lack of data on the experience of end-of-life care for head and neck cancer patients, according to a new study published in Otolaryngology -- Head and Neck Surgery (May 2011, Vol. 144:5, pp. 733-739).
As discussed in this study, a U.S. Department of Veterans Affairs group has developed the Family Assessment of Treatment at End-of-Life (FATE) survey, which is administered to families of deceased veterans. The purpose of the survey is to assess the quality of treatment at the end of patients' lives to provide better end-of-life care to head and neck cancer patients.
The study accessed patient information from the Head and Neck Cancer Specialized Program of Research Excellence (SPORE) database established by the University of Michigan. The overall response rate was 20%.
The majority of the patient population included those with advanced stage tumors, with T3 or T4 primaries. Of these patients, 55% had laryngeal cancer at the time of death, which included those with disease in the head and neck, and approximately one-third died of distance metastases.
The study results show that, compared with the patients who died at home or in a hospice, the approximately one-third of those who died in the hospital had a significantly lower FATE score, indicating less satisfaction with end-of-life care.
Since many advanced tumors are given a poor prognosis, palliative care is provided to allow for timely management of pain, the study authors wrote. It is important to note that not all patients with head and neck cancer will receive exceptional care at the end of life. Studies show that 22% of patients had family members present at the time of death, with only 33% stating they felt comfortable with their primary care provider, and only a small number stating symptom control was adequate. The data received from patients receiving palliative care resulted in a higher FATE score, suggesting that treatments may improve the quality of patients' lives.
It is important to note that when social factors or further circumstances impact care, palliative care may be beneficial even when death is not imminent, the authors wrote. The evidence in the study suggests that changes in care standards may benefit future patients, they concluded.
