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Canadian Family Physician•Le Médecin de famille canadien Vol 52: july • juillet 2006Helping expectations become reality for dying cancer patients
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e read with interest the editorial by Drs Lehmann and Daneault in the April issue entitled “Palliative care. First and foremost the domain of family physi- cians.”1 The authors point out the need for improve- ments in end-of-life care by family practitioners and note that improvements in residency training programs could facilitate greater understanding and better man- agement of end-of-life symptoms.This is especially important among patients dying from cancer, which is roughly one third of deaths in Canada. We know that, if given the choice, more than 70% of patients dying from cancer would prefer to die at home.2 Data from our centre indicate that only 42%
of patients dying of breast cancer actually achieve a home death.3 Data from across the country indicate even lower rates of 20% to 30% in Nova Scotia4 and 7% in Quebec5 for patients dying of cancer. This might be due, in part, to trends toward increased aggressive- ness of care at the end of life, but it is also the result of
scarce resources for palliative management at home.
The low incidence of home death has been associated with a low rate of palliative care referral and a high rate of specialist care at the end of life.5
Integrating palliative care into residency training programs in family medicine is a step in the right direction. Because cancer patients account for the largest proportion of deaths, however, it might also be beneficial to ensure exposure to oncology during training to enable better transition from specialist care to family physician–based care toward the end of life.
By working together we hope to improve our care of cancer patients at the end of life and ensure that expectations of dying cancer patients and their fami- lies are met.
—Christine Simmons, md
—Mark Clemons, md Toronto, Ont by e-mail References
1. Lehmann F, Daneault S. Palliative care. First and foremost the domain of family physicians. Can Fam Physician 2006;52:417-8 [Eng], 424-5 [Fr].
2. Hays JC, Galanos AN, Palmer TA, McQuoid DR, Flint EP. Preference for place of death in a continuing care retirement community. Gerontologist 2001;41:123-8.
3. Clemons M, Simmons C, Sue J, Fralick J, Fralick M, Blair A, et al. Dying with breast cancer—an audit. Breast Cancer Res Treat 2005;94(Suppl 1):3076.
4. Burge F, Lawson B, Johnston G. Trends in the place of death of cancer patients, 1992-1997. CMAJ 2003;168(3):265-70.
5. Gagnon B, Mayo NE, Hanley J, MacDonald N. Pattern of care at the end of life: does age make a difference in what happens to women with breast can- cer. J Clin Oncol 2004;22(17):3458-65.
Make your views known!
Contact us by e-mail at letters.editor@cfpc.ca, on the College’s website at www.cfpc.ca, by fax to the Scientific Editor at 905 629-0893, or by mail.
Canadian Family Physician
College of Family Physicians of Canada 2630 Skymark Ave, Mississauga, ON L4W 5A4
… Faites-vous entendre!
Communiquez avec nous par courriel : letters.editor@cfpc.ca,au site web du Collège : www.cfpc.ca, par télécopieur au Rédacteur scientifique à 905 629-0893, ou par la poste.
Le Médecin de famille canadien
Collège des médecins de famille du Canada 2630 avenue Skymark, Mississauga, ON L4W 5A4
FOR PRESCRIBING INFORMATION SEE PAGE 919
