Euthanasia requests and cancer types in the Netherlands: is there a relationship?

Cancer patients have generally requested for euthanasia and assisted suicide (EAS) more frequently than others. However, different terminal cancers are accompanied by different clinical courses. This study seeks to explore the relationship, if any, between EAS requesters and cancer types, as relates to the provision of end-of-life care in the Netherlands.

Standardized questionnaires were retrospectively sent to all general practitioners (GPs) in 10 of 23 GP-districts in the Netherlands. Of the 3614 respondents (60%), 1442 could describe a most recent EAS request from a cancer patient.

Compared to all home cancer deaths, lung, pancreas, stomach oesophagus, lip-mouth-throat cancers and melanomas occur more frequently in the group of cancer patients who requested for EAS; while prostate, haemo-lymphatic, urinary tract, bladder and uterus cancer occur relatively less frequently. Vomiting, shortness of breath and anxiousness were symptoms positively associated, and old age was negatively associated with cancers in which patients relatively frequently request for EAS.

There are differences in the extent to which patients with different cancer types request for EAS. Although shortness of breath, vomiting and anxiousness are associated with cancer types in which patients relatively frequently request for EAS, most symptoms are not associated with this. Possibly a common pathway, including more existential concerns, is important in the last stages of life.