Pattern of Care at the End of Life: Does Age Make aDifference in What Happens to Women WithBreast Cancer?

In the last 40 years, palliative care has become the standard of care at the end of life.Support system to help patients live as actively as possible until death; and it offers a support system to help the family cope during the patients illness and in their own bereavement.

The WHO1 Expert Committee defined palliativecare as the active total care of patientswhose disease is not responsive to curativetreatmentControl of pain; of other symptoms;and of psychological, social, and spiritualdistress is paramountThe goal ofpalliative care is the achievement of the bestpossible quality of life for patients and theirfamilies

Palliative care programs have clearly improved the quality of life of patients with advanced cancer and their families. Reports on the value of hospices, home care programs, specialized palliative care teams in hospitals, and regional programs, have shown proven benefits to patients and families

Earle et al, in astudy of potential indicators of good end-of-life cancer care, confirmed that home death is preferred, as opposed to hospital deathIn general, cancer patients experience a marked decline in their physical function in their last 6months of life,associated with increased symptom severity.

In the case of cancer care, it is imperative to distinguish between the terminally ill from cancer :1.Those whose death was preceded by a clinical state characterized by metastatic cancer and slow deterioration before death (dying of cancer)

2.those who died from complications of cancer treatment at an early stage (died of cancer treatment)

3. those who were diagnosed previously with cancer but were in remission and died from other illnesses such as chronic obstructive pulmonary disease or heart failure (died with cancer)

Breast cancer, the second leading cause of cancer death in women. When breast cancer spreads beyond regional lymph nodes, it becomes an irreversible progressive fatal illness.Breast cancer also affects women of all ages, from the young to the elderly

Furthermore,under a medical approach to care, women, particularly young women, would receive an array of curative treatments and procedures almost until death. Older women would likely be treated less aggressively. Hence, the medical or curative model would tend to overtreat the younger women and to accept more easily the dying process in the older women.

The indicators of the last hospital admission leading to death were created with the objective of distinguishing between terminal admissions due to insufficient access to palliative care beds and medical admissions.

The cut point of 7 days was chosen, as physicians were likely to recognize the terminal state of the women. With the possibility of imminent death, even if physicians have difficulties in predicting death, they would be more likely to limit their interventions and shift services more toward providing comfort care and family counseling, and limiting consultation to a palliative care specialist.