gms | German Medical Science

Introduction: Scientific publications on patients with carcinoma in the oral cavity, larynx and pharynx usually refer to new therapy approaches and successes that are connected to curatively aligned medicine. Even though half of these patients cannot be healed as such even now, reports on the time from determination of incurability are rare. The better and the more sufficient palliative-medical support of patients with life-shortening diseases with a high symptom load is, the lesser will the call for active euthanasia, of doctor-assisted suicide, be in society. Palliative-medicine offers available to the patient are general out-patient palliative care (Allgemeine Ambulante Palliativversorgung; AAPV) and specialist out-patient palliative care (Spezialisierte Ambulante Palliativversorgung; SAPV), palliative wards and hospices. They serve the objective of maintaining the quality of life and self-determination of most severely ill persons and to enable them to live a dignified life until death. Ethics consulting has been implemented to offer support with decisions about therapy waiver, therapy limitation or palliative sedation.

Methods: The prerequisite for the prescription of SAPV is that the disease is not curable, that it is progressive and that it has already progressed far. Incurable ENT carcinoma patients with strong exulcerating tumours, severe pain and impairment of breathing, swallowing and speech meet these criteria. The integration of palliative-medical offers in case of malignancies in the head and neck area is in any case indicated if the tumour shows no remission after oncological causative therapy, at a loco-regional tumour recurrence and in case of remote metastases.

Approx. 31,000 deaths were registered in Saxony-Anhalt in 2013. In a quarter of those, malign new formations were the cause of death. Head-neck malignancies were a small proportion at 515 cases. The incurable carcinomas were often found in the oral cavity and pharynx. There was comprehensive research to record the degree of palliative-medicine care for patients with incurable head-neck carcinoma in Saxony-Anhalt in 2013. The documentation was, unfortunately, not consistent. Nevertheless, it has been possible to map the status of palliative care for these tumour localisations in an indicative and reliable model.

Results: According to a 2012 survey among healthy persons, 75% of them wanted to die in their usual environment if they suffered from cancer. The reality is that only one third of all persons in Germany are dying at home today; 100 years ago, this rate was at 90%.

47% of the patients with incurable head-neck malignancies died in hospital, 32% at home, 13% in the nursing home and 8% in the hospice. The time that the deceased stayed in the hospital was 12–14 days, in the hospice 2–180 days. The hospice stay until death was 2–7 days for half the hospice patients with incurable head-neck carcinoma. An SAPV team supported a most severely ill or dying person for 20 days on average.

The demand for SAPV care must be estimated to reach at least 65% in patients with incurable ENT tumours. Only 23% of the patients were supported by an SAPV team at home and in the nursing home.

Conclusion: The palliative-medicine care for patients with incurable ENT malignancies is undersized. Precise demand planning is a prerequisite and reason for expansion of palliative-medicine offers. The overlap of subject-specific oncology and palliative medicine should be accepted, and palliative medicine should be integrated early. This also includes that the acquisition of palliative-medicine knowledge be mandatory for further education as a specialist doctor.