Families happier with less aggressive end-of-life cancer care

Families may be more satisfied with end-of-life care for loved ones dying of cancer when treatment is focused on comfort rather than aggressive treatment and provided outside of a hospital, a U.S. study suggests.

When patients received at least three days of hospice care focused on comfort and quality of life, 59 percent of their loved ones thought their treatment was excellent, compared with just 43 percent when patients received little or no hospice care, the study found.

At the same time, family members of cancer patients admitted to an intensive care unit (ICU) in the last month of life reported excellent care just 45 percent of the time, compared with 52 percent when patients didn’t receive this type of aggressive treatment.

“Interventions should focus more on increasing early hospice enrollment and decreasing ICU admissions and hospital deaths,” said lead study author Dr. Alexi Wright of Harvard Medical School and Dana-Farber Cancer Institute in Boston.

“The best way to do this is to encourage patients, physicians and family members to talk about their end-of-life wishes,” Wright added by email.

Many patients with advanced cancer receive aggressive medical care during their dying days even though growing evidence suggests that high-intensity treatments may not be associated with better quality of life or outcomes for patients, or an easier bereavement for the loved ones they leave behind, Wright and colleagues report in JAMA.

For the current study, researchers interviewed family members and close friends of 1,146 patients aged 65 and older who died of lung or colorectal cancers.

In most patients, the cancer had spread beyond the original location to other tissue and organs.

Overall, 51 percent of relatives and friends rated their loved ones’ end-of-life care as excellent, and another 29 percent said the quality of care was very good.

When patients had received at least three days of hospice care, most family members – 73 percent – said their loved ones had died where they wanted to. But when patients got little or no hospice care, only 40 percent of participants said the death happened in the location of the patient’s choice.

When patients died in the hospital, just 42 percent of their loved ones reported excellent care, compared with 57 percent when patients didn’t die in a hospital.

It’s possible that hospitalized patients didn’t get good pain or symptom management or emotional and spiritual support, said Dr. David Casarett, director of palliative care for Penn Medicine in Philadelphia.

“Hospice is very good at providing that sort of support and is designed to help people remain in their homes,” Casarett, who wasn’t involved in the study, said by email.

It’s also possible that families with loved ones in the ICU didn’t have a chance to come to terms with the patient’s death, and were more surprised by the course that events took, Casarett added.

The findings underscore the importance of having family discussions about wishes for end-of-life care and communicating clearly with healthcare providers about these preferences, Casarett said.

If hospice is preferable to more aggressive treatment, it’s crucial to communicate that as early as possible.
Source: fox news

Five tips for healthy and strong bones

Eating a diet rich in calcium and vitamin D is very important to keep your bones healthy and strong. Human bones which are lost and then rebuilt in tiny amounts throughout life attain peak bone density by the age of 30. However, post 30, one tends to lose slightly more bone mass than one gains.

To have a healthy bone mass and to prevent conditions like osteoporosis it is important to eat healthy. Here are a few tips:

  1. Boost calcium consumption: Calcium is an essential mineral for the proper development of teeth and bones. Dairy products that include yogurt, cheese, milk and green leafy vegetables like spinach and collard greens are a great source of calcium.
  2. Get some sunshine: Including only calcium rich food will not help improve bone density as the body won’t absorb the calcium until and unless you have enough Vitamin D.
    Sunlight is the best and natural source of vitamin D – also called the ‘sunshine vitamin’ since it s formed in the skin through exposure to ultraviolet rays from the sun. Around 15 minutes of sun exposure is enough to provide the required amount of vitamin D.
    One can even boost Vitamin D by eating sea foods like shrimp, sardines, tuna, salmon; fortified cereals and egg yolks.
  3. Keep a check on protein intake: Too much of anything is not good. And this holds true for protein as well, which otherwise plays an important role in building healthy and strong bones. Excess of protein changes the pH balance in the body. This creates an acidic environment which can result in bone loss.
  4. Cut back on salt: Most of us consume much more than the recommended 2300 milligrams of sodium per day. A high intake of sodium means, more calcium is wasted through urine and sweat. Excessive sodium intake is also a risk factor for bone fragility.
  5. Go easy on caffeine, soda: Too much of caffeine can interfere with the body`s ability to absorb calcium. The more caffeine you consume, higher is the amount of calcium pulled into the urine. Phosphorus, in the form of flavouring agent phosphoric acid in soda also interferes with calcium absorption. Hence, moderation is the key.

Source: Zee News