Why I Won't Stop Treating Patients at the End of Life

When I walked into the patient's room, I could tell that things weren't going well.

Ravi B. Parikh, MD, MPP

If there was anybody I would be nervous to treat with further therapy, it would be her. This was during my first block of consults on the solid tumor oncology service. I'd been asked by the primary team to have an end-of-life conversation with an elderly woman with metastatic non–small cell lung cancer.

Despite her shortness of breath, weight loss, exhaustion, and cancer progression, it didn't take long for her to ask me what the next step was in her treatment.

It was the moment for which I'd received extensive training in palliative care throughout my fellowship. I began going through the list of questions and phrases I'd learned to convey my concerns about her receiving more treatment.

Feeling confident that I had explored her end-of-life wishes and communicated that more treatment may not be the best idea, I then asked her what her thoughts were.

"I'd like to give treatment one last shot," she said.

When I pointed out to her outpatient oncologist afterward that I was nervous about offering her more therapy, given her current symptoms and age, she said, "I agree with you, but if she is healthy enough to make it to her appointment, then I will consider treating her if she wants it."