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- Title
End-of-Life Symptom Burden among Patients with Cancer Who Were Provided Medical Assistance in Dying (MAID): A Longitudinal Propensity-Score-Matched Cohort Study.
- Authors
Russell, K. Brooke; Forbes, Caitlin; Qi, Siwei; Link, Claire; Watson, Linda; Deiure, Andrea; Lu, Shuang; Silvius, James; Kelly, Brian; Bultz, Barry D.; Schulte, Fiona
- Abstract
Simple Summary: Cancer is the most common medical condition among Canadians who receive Medical Assistance in Dying (MAID). We aimed to evaluate if people who choose MAID have worse symptoms compared to those who do not. Using data from cancer patients in Alberta who died between July 2017 and January 2019, we carefully compared two groups: those who received MAID (n = 149) and those who did not receive MAID (n = 149). Both groups had worsening symptoms in the year before death. Those who received MAID had slightly worse anxiety and slightly worse lack of appetite than those who did not receive MAID. Overall, our results showed that symptoms between the groups were similar, and that those who received MAID did not have worse overall symptoms. This study highlights the importance of regular symptom screening and early symptom intervention for all patients with advancing cancer. Cancer is the primary underlying condition for most Canadians who are provided Medical Assistance in Dying (MAID). However, it is unknown whether cancer patients who are provided MAID experience disproportionally higher symptom burden compared to those who are not provided MAID. Thus, we used a propensity-score-matched cohort design to evaluate longitudinal symptom trajectories over the last 12 months of patients' lives, comparing cancer patients in Alberta who were and were not provided MAID. We utilized routinely collected retrospective Patient-Reported Outcomes (PROs) data from the Edmonton Symptom Assessment System (ESAS-r) reported by Albertans with cancer who died between July 2017 and January 2019. The data were analyzed using mixed-effect models for repeated measures to compare differences in symptom trajectories between the cohorts over time. Both cohorts experienced increasing severity in all symptoms in the year prior to death (β from 0.086 to 0.231, p ≤.001 to.002). Those in the MAID cohort reported significantly greater anxiety (β = −0.831, p =.044) and greater lack of appetite (β = −0.934, p =.039) compared to those in the non-MAID cohort. The majority (65.8%) of patients who received MAID submitted their request for MAID within one month of their death. Overall, the MAID patients did not experience disproportionally higher symptom burden. These results emphasize opportunities to address patient suffering for all patients with cancer through routine collection of PROs as well as targeted and early palliative approaches to care.
- Subjects
ALBERTA; ASSISTED suicide; REPEATED measures design; PALLIATIVE treatment; DEATH; RESEARCH funding; SYMPTOM burden; CANCER patients; ANXIETY; APPETITE; DESCRIPTIVE statistics; LONGITUDINAL method; HEALTH outcome assessment; COMPARATIVE studies; TERMINALLY ill; SUFFERING
- Publication
Cancers, 2024, Vol 16, Issue 7, p1294
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16071294