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Men less likely than women to accept palliative care

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Fahad Saeed

Men with cancer appeared three times less likely than women with cancer to consider palliative care, according to study results.

Fahad Saeed, MD, assistant professor in the departments of medicine and public health sciences at University of Rochester Medical Center, and colleagues investigated whether men — as well as individuals with low educational attainment levels — were less likely to receive palliative care.

The cross-sectional analysis of the Values and Options in Cancer Care (VOICE) study included data from 383 patients. The researchers defined palliative care as “comfort care” that focused on quality of life but not cure.

Results showed women were more than three times as likely as men (OR = 3.07; 95% CI, 1.8-5.23) to prefer palliative care.

HemOnc Today spoke with Saeed about what prompted the investigation, the explanations for the results observed, and how this disparity in palliative care acceptance based on sex can be reduced.

Question: What prompted you to study this topic?

Answer: I saw a patient who was a military veteran and a tough man. He was so resistant to the idea of palliative care. I discussed with my study collaborator — Paul Duberstein, MD — that perhaps there are differences between men and women regarding use of palliative care. We did a subanalysis of the VOICE study to test this hypothesis and, lo and behold, the results proved our hypothesis.

Q: So it was just one patient?

A: Just one patient. Clinical observations generate research hypotheses. That patient encounter was so striking and left an impression.

A: The VOICE study is an intervention to help clinicians and patients engage in communication regarding their cancer treatments. Patients often struggle with the question of what palliative care is. For this study, we defined palliative care for them. We used a practical example of what it is, which involved this question: “If your cancer doctor tells you that your current treatment methods aren’t working, would you be willing to accept palliative care?” The majority of patients were open and willing to accept palliative care. However, there was a small percentage of patients that would not accept it. In that small group, men were three times more likely than women to deny palliative care.

Q: Why do you think that is?

A: In this study, we didn’t specifically look at the mechanistic explanation. There are societal expectations of men to be tough and to be a warrior. If cancer is a war, accepting palliative care may be a psychological defeat and men must beat cancer by fighting against it.

Q: It seems two separate issues could be causing this phenomenon. One is the perceived expectations that men be tough, and the other is that palliative care is defined differently from person to person and from institution to institution. Could you discuss how each factor may relate to your study?

A : To that first point, men feel their role is to be a fighter all the time. In most cases, this is a good thing. One needs a certain degree of fighting spirit to deal or cope with cancer. But one also needs to understand when to change the role from fighting to acceptance of comfort. It’s not clear to everyone where that line is, and it may vary from patient to patient. This is where cancer doctors and patients’ families can help with decision-making.

With regard to the question about variation in definitions of palliative care, for this study, we made sure to give patients a specific clinical scenario so there was no room for misinterpretation. For stronger research methodology, we operationalized our definition.

Q: Would standardizing palliative care help to alleviate some of these disparities?

A: Definitely. In real life, people confuse palliative care with hospice, which is end-of-life care. We need to convey the message that palliative care can be delivered concurrently even with the most aggressive therapy. Palliative care is a basic human right. It is simply an effort to offer comfort while a patient may be pursuing the most aggressive forms of treatments, such as dialysis or chemotherapy. Men need to learn that palliative care doesn’t equate to giving up.

Q: Are you developing specific approaches to help men understand what palliative care is and why it may be beneficial ?

A: In clinics and real clinical practice, clinicians need to be curious about why certain men are resistant to the idea of palliative care. It may be just a misinterpretation of palliative care philosophy. If a physician would simply take the time to explain that palliative care doesn’t mean giving up, men may open up to the idea. If the issue is deep-rooted and surrounded by issues of masculinity, then physicians and family members need to give men permission to be vulnerable. It is a matter of reframing the discussion and redefining roles. They need to tell the man, “You’ve taken care of us all your life. Now, it’s our turn to take care of you.” Maybe it is possible to tell these men that now is the time to fight for their comfort. If a patient is comfortable, it enhances not only the quality of life of the patient, but also the quality of life of the family members.– by Rob Volansky

Reference:

Saeed F, et al. J Pain Symptom Mgmt. 2018;doi:10.1016/j.jpainsymman.2018.03.014.

For more information:

Fahad Saeed, MD, can be reached at Strong Memorial Hospital, UR Medicine, 601 Elmwood Ave., Rochester, NY 14642; email: fahad_saeed@urmc.rochester.edu.

Disclosure: Saeed reports no relevant financial disclosures.