Study Sheds Light on Physician-Assisted Suicide in Lung Cancer Patients

Patients diagnosed with lung cancer who opted for “medical assistance in dying” often proceeded without consultation with their radiation oncologist or medical oncologist, a researcher said.

In a Canadian study of 45 individuals diagnosed with lung cancer who used medical assistance in dying (also known as physician-assisted suicide), about 20% did not have a radiation oncologist involved when making the decision and 22% did not have a consultation with a medical oncologist, said Sara Moore, MD, of Ottawa Hospital Research Institute of the University of Ottawa.

In the time since medical assistance in dying became law in Canada through court intervention in 2016, about 60% of those seeking to end their life in that way had been diagnosed with cancer, Moore explained in an oral presentation at the virtual World Conference on Lung Cancer.

The designated discussant for the study, Monica Malec, MD, a geriatric and palliative care physician at the University of Chicago, said the study is the first to evaluate medical assistance in dying in patients with lung cancer, oncologists’ involvement, and treatment history.

“The demand for medical assistance in dying is increasing and is becoming more readily available to patients,” Malec said. “Patients are seeking this option despite the availability of more effective and more tolerable treatment options. Existing literature suggests that loss of autonomy, control, and dignity are the primary drivers for seeking medical assistance in dying rather than uncontrolled symptoms, and the decision to pursue medical assistance in dying may occur pre-illness.”

Moore noted that while lung cancer accounts for 20%-25% of all cancer deaths overall, in the current study 17.5% of the patients had lung cancer diagnoses. “Lung cancer comprises slightly fewer medical assistance in dying cases than expected compared to lung cancer death rates,” she said.

“Biomarker-driven targeted therapy and immunotherapy offer effective and tolerable new treatments, but a subset of patients undergo medical assistance in dying without accessing — or, in some cases, without being assessed for — these treatment options,” Moore continued. “Most patients were assessed by an oncology specialist, though less than half received systemic therapy.”

“Given the growing number of efficacious and well-tolerated treatment options in lung cancer, consultation with an oncologist may be reasonable to consider for all patients with lung cancer who request medical assistance in dying,” she said.

Moore and her colleagues reviewed data from the Ottawa region, and identified 256 patients with a cancer diagnosis who had used medical assistance in dying. Non-thoracic malignancies accounted for 208 of those individuals, and three others were diagnosed with mesothelioma. The remaining 45 patients had a lung cancer diagnosis.

Thirteen of these patients had no biopsy confirmation of their disease, but nearly all (91%) of the patients who opted for medical assistance in dying were diagnosed with metastatic disease. The time from diagnosis to death in this population was 17 weeks.

The patients in the study were about 72 years old, and 64% (29 of the 45 patients with lung cancer) were women, even though men are more often diagnosed with lung cancer, Moore noted.

About equal percentages of the individuals were in relationships, single, or widowed. About 85% of the patients in the study had a history of tobacco smoking, and 36% were current smokers at the time they sought medical assistance in dying, Moore reported.

Study limitations, she said, are that the results pertain to a single region only, and there was a lack of information on patients’ decision-making process.