End-of-life care

End-of-life care

End-of-life care is distinct from palliative care. Patients treated - palliatively may survive for many years; end-of-life care concerns the last few months of a patient’s life. Many issues, such as symptom control, are common to both palliative care to the sense of approaching death. These include a heightened sense of spiritual need, profound fear and the specific needs of those who are facing bereavement. The concept of a ‘good death’ has been embedded in many cultures over many centuries. Healthcare professionals deal with many deaths and sometimes forget that the patient who hopes for a good death has only one chance to get it right. This is why end-of-life care is worth considering in its own right and not as a mere appendage to palliative care. Summary box 12.5 Issues at the end of life /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Allison JP . Immune checkpoint blockade in cancer therapy: the 2015 Lasker–DeBakey Clinical Medical Research Award. JAMA 2015; 314 (11): 1113–14. Atun R, Ja ff ray DA, Barton MB et al. Expanding global access to ra - diotherapy . Lancet Oncol 2015; 16 (10): 1153–86. Bailar JC 3rd, Gornik HL. Cancer undefeated. N Engl J Med 1997; 336 (19): 1569–74. Doll R. The Pierre Denoix Memorial Lecture: nature and nurture in the control of cancer. Eur J Cancer 1999; 35 (1): 16–23. Hanahan D, Weinberg RA. The hallmarks of cancer. Cell 2000; 100 (1): 57–70. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell 2011; 144 (5): 646–74. Martincorena I, Raine KM, Gerstung M et al. Universal patterns of selection in cancer and somatic tissues. Cell 2017; 171 (5): 1029–41. Meara JG, Leather AJM, Hagander L et al . Global surgery 2030: ev - idence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386 (9993): 569–624. Murtaza M, Dawson SJ, Tsui D et al. Non-invasive analysis of acquired resistance to cancer therapy by sequencing of plasma DNA. Nature 2013; 497 (7447): 108–12. Solda F , Lodge M, Ashley S et al . Stereotactic radiotherapy (SABR) for the treatment of primary non-small cell lung cancer; systematic re - view and comparison with a surgical cohort. Radiother Oncol 2013; 109 (1): 1–7. Tomasetti C, V ogelstein B. Cancer etiology . Variation in cancer risk among tissues can be explained by the number of stem cell divi - sions. Science 2015; 347 (6217): 78–81. Tree AC, Khoo VS, Eeles RA et al. Stereotactic body radiotherapy for oligometastases. Lancet Oncol 2013; 14 (1): e28–e37. Weinberg RA. The biology of cancer, 2nd edn. New Y ork, London: Gar - land Science, 2013. Wu S, Powers S, Zhu W , Hannun YA. Substantial contribution of ex - trinsic risk factors to cancer development. Nature 2016; 529 (7584): 43–7.

Appropriateness of active intervention Euthanasia Physician-assisted suicide Living wills Bereavement Spirituality Support to allow death at home The problem of the medicalisation of death

End-of-life care

End-of-life care is distinct from palliative care. Patients treated - palliatively may survive for many years; end-of-life care concerns the last few months of a patient’s life. Many issues, such as symptom control, are common to both palliative care to the sense of approaching death. These include a heightened sense of spiritual need, profound fear and the specific needs of those who are facing bereavement. The concept of a ‘good death’ has been embedded in many cultures over many centuries. Healthcare professionals deal with many deaths and sometimes forget that the patient who hopes for a good death has only one chance to get it right. This is why end-of-life care is worth considering in its own right and not as a mere appendage to palliative care. Summary box 12.5 Issues at the end of life /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Allison JP . Immune checkpoint blockade in cancer therapy: the 2015 Lasker–DeBakey Clinical Medical Research Award. JAMA 2015; 314 (11): 1113–14. Atun R, Ja ff ray DA, Barton MB et al. Expanding global access to ra - diotherapy . Lancet Oncol 2015; 16 (10): 1153–86. Bailar JC 3rd, Gornik HL. Cancer undefeated. N Engl J Med 1997; 336 (19): 1569–74. Doll R. The Pierre Denoix Memorial Lecture: nature and nurture in the control of cancer. Eur J Cancer 1999; 35 (1): 16–23. Hanahan D, Weinberg RA. The hallmarks of cancer. Cell 2000; 100 (1): 57–70. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell 2011; 144 (5): 646–74. Martincorena I, Raine KM, Gerstung M et al. Universal patterns of selection in cancer and somatic tissues. Cell 2017; 171 (5): 1029–41. Meara JG, Leather AJM, Hagander L et al . Global surgery 2030: ev - idence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386 (9993): 569–624. Murtaza M, Dawson SJ, Tsui D et al. Non-invasive analysis of acquired resistance to cancer therapy by sequencing of plasma DNA. Nature 2013; 497 (7447): 108–12. Solda F , Lodge M, Ashley S et al . Stereotactic radiotherapy (SABR) for the treatment of primary non-small cell lung cancer; systematic re - view and comparison with a surgical cohort. Radiother Oncol 2013; 109 (1): 1–7. Tomasetti C, V ogelstein B. Cancer etiology . Variation in cancer risk among tissues can be explained by the number of stem cell divi - sions. Science 2015; 347 (6217): 78–81. Tree AC, Khoo VS, Eeles RA et al. Stereotactic body radiotherapy for oligometastases. Lancet Oncol 2013; 14 (1): e28–e37. Weinberg RA. The biology of cancer, 2nd edn. New Y ork, London: Gar - land Science, 2013. Wu S, Powers S, Zhu W , Hannun YA. Substantial contribution of ex - trinsic risk factors to cancer development. Nature 2016; 529 (7584): 43–7.

Appropriateness of active intervention Euthanasia Physician-assisted suicide Living wills Bereavement Spirituality Support to allow death at home The problem of the medicalisation of death

End-of-life care

End-of-life care is distinct from palliative care. Patients treated - palliatively may survive for many years; end-of-life care concerns the last few months of a patient’s life. Many issues, such as symptom control, are common to both palliative care to the sense of approaching death. These include a heightened sense of spiritual need, profound fear and the specific needs of those who are facing bereavement. The concept of a ‘good death’ has been embedded in many cultures over many centuries. Healthcare professionals deal with many deaths and sometimes forget that the patient who hopes for a good death has only one chance to get it right. This is why end-of-life care is worth considering in its own right and not as a mere appendage to palliative care. Summary box 12.5 Issues at the end of life /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF Allison JP . Immune checkpoint blockade in cancer therapy: the 2015 Lasker–DeBakey Clinical Medical Research Award. JAMA 2015; 314 (11): 1113–14. Atun R, Ja ff ray DA, Barton MB et al. Expanding global access to ra - diotherapy . Lancet Oncol 2015; 16 (10): 1153–86. Bailar JC 3rd, Gornik HL. Cancer undefeated. N Engl J Med 1997; 336 (19): 1569–74. Doll R. The Pierre Denoix Memorial Lecture: nature and nurture in the control of cancer. Eur J Cancer 1999; 35 (1): 16–23. Hanahan D, Weinberg RA. The hallmarks of cancer. Cell 2000; 100 (1): 57–70. Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell 2011; 144 (5): 646–74. Martincorena I, Raine KM, Gerstung M et al. Universal patterns of selection in cancer and somatic tissues. Cell 2017; 171 (5): 1029–41. Meara JG, Leather AJM, Hagander L et al . Global surgery 2030: ev - idence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386 (9993): 569–624. Murtaza M, Dawson SJ, Tsui D et al. Non-invasive analysis of acquired resistance to cancer therapy by sequencing of plasma DNA. Nature 2013; 497 (7447): 108–12. Solda F , Lodge M, Ashley S et al . Stereotactic radiotherapy (SABR) for the treatment of primary non-small cell lung cancer; systematic re - view and comparison with a surgical cohort. Radiother Oncol 2013; 109 (1): 1–7. Tomasetti C, V ogelstein B. Cancer etiology . Variation in cancer risk among tissues can be explained by the number of stem cell divi - sions. Science 2015; 347 (6217): 78–81. Tree AC, Khoo VS, Eeles RA et al. Stereotactic body radiotherapy for oligometastases. Lancet Oncol 2013; 14 (1): e28–e37. Weinberg RA. The biology of cancer, 2nd edn. New Y ork, London: Gar - land Science, 2013. Wu S, Powers S, Zhu W , Hannun YA. Substantial contribution of ex - trinsic risk factors to cancer development. Nature 2016; 529 (7584): 43–7.

Appropriateness of active intervention Euthanasia Physician-assisted suicide Living wills Bereavement Spirituality Support to allow death at home The problem of the medicalisation of death