End-of-life decision-making across cancer types: results from a nationwide retrospective survey among treating physicians

BACKGROUND: The treatment of advanced cancer often involves potentially life-shortening end-of-life decisions (ELDs). This study aimed to examine the prevalence and characteristics of ELDs in different cancer types. METHODS: A nationwide death certificate study was conducted based on a large random sample of all deaths in Flanders, Belgium, between 1 January and 30 June 2013. All cancer deaths were selected (n = 2392). Attending physicians were sent a questionnaire about ELDs and the preceding decision-making process. RESULTS: The response rate was 58.3%. Across cancer types, a non-treatment decision occurred in 7.6–14.0%, intensified pain and symptom alleviation in 37.5–41.7%, euthanasia or physician-assisted suicide in 8.7–12.6%, and life shortening without explicit patient request in 1.0–2.4%. ELD prevalence did not differ significantly by cancer type. Reasons for ELDs were most frequently patient’s physical suffering and lack of prospect of improvement. ‘Anticipated further suffering’ and ‘unbearable situation for relatives’ were reasons more often reported in haematological cancer than in other cancer types. Patient, family, and caregiver involvement in decision-making did not differ across cancer types. CONCLUSIONS: Euthanasia or physician-assisted suicide rates were relatively high in all cancer types. Neither the prevalence of ELDs nor characteristics of the decision-making process differed substantially between cancer types. This indicates a uniform approach to end-of-life care, including palliative care, across oncological settings.