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Palliative Care Preferences in Male Patients With Cancer

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Key Points

  • Men with advanced cancer are 30% less likely than women to consider palliative care.
  • The research is consistent with other studies showing that men also are less likely to sign do-not-resuscitate orders at the end of life.
  • The study noted that physicians should take into account gender differences while talking about palliative care and be mindful of a tendency for some patients to be stoic and invulnerable.

Men with advanced cancer are 30% less likely than women to consider palliative care, according to a University of Rochester Medical Center (URMC) study. Researchers believe the findings reflect social norms about gender roles, as well as widespread messages in the media and society about “fighting” cancer. These findings were published by Saeed et al in the Journal of Pain and Symptom Management.

“There is an ethos of ‘fight, fight, fight,’ and there is nothing wrong with that,” added Timothy E. Quill, MD, an internationally recognized pioneer in palliative care. “But if all you do is fight and you ignore the emotional and spiritual aspects of what’s happening, it’s a missed opportunity to look at life in a different way.”

Methods

Scientists analyzed data from 383 individuals with advanced cancer between the ages of 22 and 90 years who had been asked about their preferences for palliative care. Response options were: definitely no, possibly no, unsure, possibly yes, and definitely yes.

The analysis accounted for other factors such as aggressiveness of the cancer, age, race, and financial status, but gender was the only factor that significantly influenced a preference for palliative care, according to the study.

For this study, palliative care was defined as comfort care, focusing on quality of life. All of the patients had advanced cancer.

Findings

Women were more likely than men to prefer palliative care (odds ratio [OR] = 3.07, 95% confidence interval [CI] = 1.80–5.23). The effect of education on preferences for palliative care was not statistically significant (OR = 0.85, 95% CI = 0.48–1.48).

Often men see themselves as the family protector. When struck with a serious illness, they usually want to be cast as a “fighter” or a “warrior” and may view palliative care as giving up, said the study’s lead author, Fahad Saeed, MD, a palliative care specialist and Assistant Professor of Medicine and Public Health Sciences at URMC. He added that the research is consistent with other studies showing that men also are less likely to sign do-not-resuscitate orders at the end of life.

Some men are hesitant to express the symptoms and emotions they are experiencing, viewing it as a sign of weakness, Dr. Saeed said. Since palliative care is all about symptom management, that becomes a problem.

Better communication around the myths and misunderstandings about palliative care might help to promote its services among men, according to the investigators, including senior author Paul Duberstein, PhD, Professor of Medicine and Psychiatry and Director of Research in the Division of Palliative Care at URMC. For example, the study noted that physicians should take into account gender differences while talking about palliative care and be mindful of a tendency for some patients to be stoic and invulnerable.

“It’s also essential for oncology care teams to work with families,” Dr. Duberstein said. “What are men fighting for? Many of them simply want more time with their loved ones, and thus, it’s important to consider the nuances of the entire family situation.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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