Sense and Nonsense of Treating Comorbid Diseases in Terminally Ill Patients

When treating terminally ill patients, doctors are often faced with making difficult decisions.

A recent study published in the Journal of the American Medical Association cited a case regarding a 69-year-old woman who had both metastic pancreatic cancer and type 2 diabetes mellitus who struggled to keep her blood glucose levels within the recommended levels. The patient was undergoing a concurrent course of palliative chemotherapy, which the author said lead to concerns from her and her husband.

As the author noted, “The physician — who had an interest in palliative care – told the patient and her husband that higher glucose levels were not a problem as long as they caused no symptoms.” What concerned the patients, according to the author was the fact that the doctor cited her “limited life expectancy,” as cause to believe that her diabetic symptoms would not worsen and cause organ damage.

While the patient was concerned that the doctor had, “thrown in the towel,” the author said the doctor assured her that was not the case at all. “In contrast, they were in fact applying tailored therapy,” the author said.

In such a sensitive time of treatment, the author noted that the doctor providing comfort in the patient’s care helped her to live her normal life without as much concern regarding other areas of potential worry.

“In the final phase of life, the goals of treatment change, and drugs used to prevent or treat chronic diseases need to be reconsidered,” the authors said.

Doctors should take into consideration that some diabetic complications can take up to a decade to develop when deliberating courses of treatments for patients on an individual basis. “In addition to limiting burden and adverse effects, discontinuing drug use in patients with limited life expectancy may actually improve quality of life and survival.”

“Continuing medication use at the end of life also has important impacts on healthcare costs,” they added. “Discontinuing statin therapy alone in patients with a life expectancy of less than 1 year could save the US health care system $603 million annually.”

As doctors routinely face patient concerns when treating terminally ill patients, “Physicians need, therefore, to consider both the physical and psychosocial effects of withdrawing treatment,” they noted. “In our case, they physician initially failed to address the patients fears, but after receiving a full explanation of the altered aims of treatment, she was very satisfied with her care.