Forgotten defibrillators needlessly shock terminally ill cancer patients

Cancer will kill more than a half million people in this country this year. Many will not go quietly. Their diseased hearts, impaired further by a losing battle against cancer, will shut down only to be shocked back to life by implanted defibrillators that could have been turned off but were not.

“As the population ages, many patients are going to have multiple, competing diseases,” said Dr. Nathan Goldstein, an assistant professor in the Brookdale Department of Geriatrics and Palliative Medicine at the Mount Sinai School of Medicine in New York City. “More and more, we will see patients who have been saved from dying of sudden cardiac failure but now are dying of cancer.”

A godsend in the fight against cardiac death, implantable defibrillators in hospice patients become an unintended lifeline to suffering. Goldstein tells of a man brought by his family from home hospice into the emergency room.

“He was being shocked over and over at home and they didn’t know what to do,” he said. “The patient died in the cardiac area, a very busy part of the emergency room, rather than being at home with his family, which is what he had wanted.”

In a first-of-its-kind study of hospice patients with implantable cardioverter defibrillators, Goldstein and colleagues found that patients admitted to hospice care rarely have their ICDs deactivated. Consequently, they are receiving electrical shocks from these devices as they reach the end of life.

Shocks from an ICD are like being kicked or punched in the chest, patients say. Family caregivers who observe their loved ones being shocked report feelings of fear, worry, and helplessness. Their experiences are associated with increased rates of depression and anxiety. When ICD shocks are administered to terminal patients in hospice, they can have a devastating effect on everyone involved.

Oncologists are in a good position to help these patients, Goldstein said, as they consider what is important specifically to each patient.

“More and more patients are coming in and saying they want to talk about quality of life, about the big picture, and not just about the cancer,” he said. “I would argue that we should never talk to patients about turning off their defibrillators but look at the larger picture and talk about their overall goals of care,” he said, “to find out what is important to them at this point in their care.”

Considering deactivation of an implanted defibrillator could be a determining factor in whether the wishes of the patient are carried out.