Differences between end-of-life care for cancer, organ failure and frailty14
| Characteristic | Cancer | Organ failure | Frailty |
|---|---|---|---|
| Trajectory | Progressive, accelerating deterioration | Unpredictable, with exacerbations and recoveries | Slow, progressive deterioration; sudden changes rare |
| Treatment | Curative/life-prolonging therapy often stopped at the time of transition to palliative care | Disease-modifying therapies provide symptom control; usually continued even for palliation | No effective disease-modifying therapies; treatment primarily supportive |
| Prognostication | Well-recognized syndromes or functional decline associated with prognosis < 6 mo | Prognostication challenging, especially beyond 3 mo; patients with “end-stage” disease can survive for years on life-sustaining therapies (e.g., dialysis) | Prognostication challenging; no reliable models for identifying final months |
| Needs/concerns | Pain/symptom control; fear of death; social and physical supports typically needed only in final weeks or months | Symptom control; decisions about life-sustaining therapies for organ failure (e.g., ventilation, dialysis, organ transplant); needs for social and physical supports often long standing and may exceed symptom burden | Functional decline, cognitive impairment greater concerns than fear of dying; symptoms variable |
| Typical patient demographics | Age 45–75 yr; often family caregiver | Age 70–85 yr; partner more likely to be deceased, or elderly and unable to provide support | Age ≥ 75 yr; partner more likely to be deceased, or elderly and unable to provide support |
| Typical patient location; composition of medical team | Community dwelling, with increasing visits to acute medical facility; care provided by single or multiple specialists (e.g., oncologist, with transition to palliative care specialist) associated with tertiary care facility | Community dwelling, with frequent visits to acute medical facility; care provided by multiple specialists or coordinated by general practitioner and a specialist; focus of care may be in tertiary care centre or primary care setting | Often residents of assisted-living or long-term care facilities; less frequent visits to acute medical facility; care generally provided by general practitioner based at assisted-living or long-term care facility; less affiliation with tertiary care centre |
| Professional/societal view of illness | Clearly viewed as life-limiting | Often viewed as chronic illness rather than life-limiting | Often not viewed as an illness |