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08-05-2012 | Cardiology | Article

Treatment often futile in end-stage noncancer patients


Free abstract

MedWire News: Findings from a systematic review suggest that aggressively treating end-stage noncancer conditions, such as renal failure and liver cirrhosis, does not extend patient survival.

When such conditions reach a terminal stage, median survival is just 6 months, say the authors. This, they explain, is because irrespective of the type of noncancer condition present, specific factors associated with 6-month survival tend to be present once a condition reaches end-stage.

These factors include poor performance status, advanced age, malnutrition, comorbid illness, increasing organ dysfunction, and hospitalization for acute decompensation.

The review involved 74 studies conducted between 1980 and 2010. These studies assessed survival rates among patients diagnosed with a terminal-stage noncancer illness.

Noncancer conditions involved in the analysis included dementia, heart failure, liver cirrhosis, chronic obstructive pulmonary disease, and renal failure.

All patients in the studies reviewed received treatments advocated by guidelines at the time of study.

Shelley Salpeter (Stanford University School of Medicine, California, USA) and co-authors report: "Our review of studies from 1980 to 2010 found similar results, indicating that survival for these end-stage illnesses has not changed significantly in the past 30 years.

"With few exceptions, these terminal presentations are quite refractory to treatment."

Writing in the American Journal of Medicine, the authors say that making treatment decisions for patients with end-stage illnesses is difficult as physicians are often faced with the task of deciding when it is futile to treat these patients.

Salpeter et al add that the results of this systematic review may assist the decision-making process, as the findings show that median survival amongst these patients remains at 6 months once two to four of the aforementioned terminal disease-specific factors manifest.

The findings also show that this survival length persists, despite the use of aggressive therapies and the type of end-stage illness.

"General guidelines were developed in the 1990s by the National Hospice Organization to help determine prognosis in selected noncancer diseases," say the authors.

They therefore conclude that "this review could serve to update and extend those guidelines, and adds new knowledge about prognosis and treatment in common end-stage noncancer diseases."

By Lauretta Ihonor

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