Stage IV cancer patients and their caregivers don't agree on the value of another year of life versus other end-of-life improvements.

Cancer is an expensive proposition emotionally and also financially. High-cost treatments may result in only moderate improvements in length or quality of life. Because such decisions are very difficult for patients to make, in some cases the decision is entirely deferred to a family caregiver.  
Scholars administered surveys to 211 patients with stage IV cancer and their informal caregivers to find out more about their end-of-life preferences. Participants were asked to choose their most-preferred end-of-life scenarios out of a series of options that varied along key dimensions, including years of life remaining, degree of pain experienced, place of death, level of burden on caregivers, quality of health care experience, cost, and source of payment (cash, Medisave, or family members' cash or Medisave).

Using the results, the authors quantified patients and caregivers willingness to pay to improve their end of life experience. They found that patients' willingness to pay to extend their life by one year was valued at S$18,570, which is lower than their willingness to pay to avoid severe pain (S$22,199), or to die at home (S$31,256), and only slightly more than their willingness to pay to receive a high-quality health-care experience (S$16,191).

Caregivers had a three-fold greater willingness to pay than patients to extend life by one year and for most of the other features considered.  

That's right, the family of cancer patients valued a year life more than the patients themselves. Cancer patients regard being free of pain and dying at home as more important considerations. 

The results suggest that health insurers and physicians may be putting too much emphasis on life extending treatments for these patients."Results highlight the importance of pain management, supporting home deaths, and addressing other end-of-life concerns, in addition to efforts to extend life," says Professor Eric Finkelstein at Duke-NUS Graduate Medical School.

Published in Palliative Medicine.