Eric Geijteman

A child with severe hearing loss associated with maternal cisplatin treatment during pregnancy

BACKGROUND: Cisplatin is considered safe to use during the second and third trimesters of pregnancy in patients with cancer. CASE: A 34-year-old pregnant woman was diagnosed with cervical cancer. She received five weekly dosages of cisplatin and paclitaxel, starting at 26 5/7 weeks of gestation. An elective cesarean delivery was performed at 34 4/7 weeks of gestation. After birth, the neonate was diagnosed with severe bilateral perceptive hearing loss. CONCLUSION: Cisplatin during the second and third trimesters of pregnancy may lead to fetal ototoxicity.

Understanding the Continuation of Potentially Inappropriate Medications at the End of Life: Perspectives from Individuals and Their Relatives and Physicians

To the Editor: Individuals with limited life expectancy often use a range of medications. These can be roughly divided into medications to treat or prevent (chronic) illnesses and those to reduce the burden of symptoms. The administration of medication with a focus on the prevention and treatment of illnesses should be reconsidered in the final stages of life (when a person’s life expectancy is months or weeks). In practice, reconsidering an individual’s medication use in the last phase of life seems to be rare. Therefore, people often take multiple medications that may not have beneficial effects in view of their limited life expectancy and changing organ function: potentially inappropriate medications (PIMs). PIMs may cause different side effects and place the burden of taking them on people. In addition, the use of PIMs involves costs. Factors contributing to the use of PIMs in the last stage of life are largely unknown. An interview study was performed to identify such factors from the perspectives of older adults and their relatives and physicians.

Denying the inevitability of death

[...] Although the definition of a good death mainly reflects the personal values of the patient, many of us agree on common factors. For example, a good death involves attending to pain and other suffering, and ensuring that the patient is aware of impending death and is able to direct his or her treatment. [...]

Interventions in hospitalised patients with cancer: the importance of impending death awareness

Objectives Burdensome and futile interventions with the aim of prolonging life should be avoided in dying patients. However, current clinical practice has hardly been investigated. We examined the number and type of diagnostic and therapeutic medical interventions in hospitalised patients with cancer in their last days of life. In addition, we investigated if physician awareness of impending death affected the use of these interventions. Methods Questionnaire study and medical record study. Attending physicians of patients who died in a university hospital between January 2010 and June 2012 were asked whether they had been aware of the patient’s impending death. The use of diagnostic and therapeutic interventions and medications was assessed by studying patients’ charts. We included 131 patients. Results In the last 72 and 24 hours of life, 59% and 24% of the patients received one or more diagnostic interventions, respectively. Therapeutic interventions were provided to 47% and 31%. In the last 24 hours of life, patients received on average 5.8 types of medication. Awareness of a patient’s impending death was associated with a significant lower use of diagnostic interventions (48% vs 69% in the last 72 hours; 11% vs 37% in the last 24 hours) and several medications that potentially prolong life (eg, antibiotics and cardiovascular medication). Conclusions Many patients with cancer who die in hospital receive diagnostic and therapeutic interventions in the last days of life of which their advantages are questionable. To improve end-of-life care, medical care should be adapted.

Melding en toetsing van levensbeëindigend handelen

SamenvattingVan der Heide A, Geijteman E, Van Delden H. Melding en toetsing van levensbeëindigend handelen. Huisarts Wet 2015;58(6):286-9.AchtergrondDe regionale toetsingscommissies euthanasie beoordelen verreweg het grootste deel van de meldingen van levensbeëindigend handelen als ‘zorgvuldig’. Wij onderzochten hoe artsen in die meldingen hun handelen onderbouwen en hoe toetsingscommissies ze beoordelen.MethodeWij trokken een steekproef uit de meldingen die in 2011 door de toetsingscommissies zijn ontvangen en analyseerden 316 dossiers.ResultatenDe wilsbekwaamheid van de patiënt werd in de verslaglegging vaak summier toegelicht, behalve als er redenen waren om daaraan te twijfelen. De meldende arts onderbouwde het lijden van de patiënt vrijwel altijd met een beschrijving van lichamelijke symptomen; in de helft van de gevallen werden psychosociale of existentiële problemen genoemd. De toetsingscommissie vroeg bij 22% van de meldingen om nadere toelichting. Daarbij ging het vaak om onduidelijkheid over de toegediende middelen. Om een toelichting op het lijden werd alleen gevraagd als de medische grondslag niet duidelijk was.ConclusieDe toetsing van levensbeëindigend handelen door artsen is een tamelijk omzichtig samenspel van artsen en toetsingscommissies. Artsen doen in het algemeen adequaat verslag van levensbeëindigend handelen. Soms is de verslaglegging summier. Vragen van de toetsingscommissies zijn vooral bedoeld om een helder beeld van het handelen te krijgen en leiden zelden tot het oordeel ‘onzorgvuldig’.AbstractVander Heide A, Geijteman E, Van Delden H. Notification and evaluation of euthanasia. Huisarts Wet 2015;58(6):286-9.BackgroundIn the large majority of cases, Dutch regional euthanasia review committees consider that euthanasia is carried out with due care. This study investigated the information doctors provide to justify their actions and how the review committees evaluate this.MethodA random sample was taken of all notifications made in 2013; 316 case files were analysed.ResultsSoundness of mind was often poorly documented, except when there were reasons to doubt the patient’s mental competence. In describing a patient’s suffering, doctors nearly always described physical symptoms; in half the reports psychosocial or other problems were also mentioned. The review committee asked for additional information in 22% of the cases, often because of a lack of clarity about the medication used. Additional information about patient suffering was requested if the medical basis for this was not clear.ConclusionEvaluation of euthanasia procedures involves rather cautious interplay between doctors and review committee. In general, doctors report their actions adequately, although sometimes the information provided is rather brief. The questions asked by review committees are generally meant to clarify the situation and seldom lead to the conclusion that a doctor has acted without due care.