Advance directives in patients with head and neck cancer – comparison of two patient collectives in early and advanced stages

Advance directives (AD), which consist of living wills (LW) and durable power of attorney fo healthcare (DPOAH), are an important component of patient autonomy. We have previously shown that less than half of outpatients with head and neck cancer possess appropriate documents. This study investigates their presence in patients with recurrent and/or metastatic (RM) head and neck cancer (HNC). In this monocentric cross-sectional study, we investigated the prevalence & availability of AD, as well as reasons for & against their creation. For this purpose, 96 patients with RM HNC, were contrasted with a collective of 389 patients at non-recurrent/metastatic (NRM) stage. 485 patients were included (male n=361, 74.4%; age Mean 62.43, SD±11.89). Among patients in RM stages, AD were present in more than half of patients & were thus 5.6% more frequent than in NRM stages (RM 52.1% vs NRM 46.5%, p=0.330, r=0.044). The proportion of patients with AD who reported also depositing it was 7.1% higher in RM patients (RM 34.0% vs NRM 26.9%, p=0.319, r=0.065). Advice from a primary care physician, relative or friend was the most common reason for creating an AD in both collectives (53.5% vs 27.7%, p=0.160, r=0.101). In both collectives, very few patients had made a conscious decision not to create an AD (7.0% vs 7.6%, p=0.246, r=0.076). The frequency and availability of AD is only slightly higher in the collective of RM patients than in NRM patients. Very few patients make a conscious decision not to have an AD. Therefore, both patient collectives should be increasingly motivated to create an AD as part of advance care planning.

Publication History

Article published online:
12 May 2023