The Decipher genomics test, which measures activity of 22 genes among seven known cancer pathways, independently estimates patients’ risk of prostate cancer metastasis, death, and overall survival and helps identify patients most likely to benefit from hormone therapy, researchers reported in study findings published in JAMA Oncology.

“I don’t want to die.”  “What is my prognosis?”  “Is this a death sentence?” 

As oncology nurses, heart-wrenching questions like these are part of our day-to-day work. So how do we address patient concerns in a compassionate yet professional way? How do we respond to a patient with stage IV cancer who exclaims they only have two more cycles of treatment until they’re cured? How do we explain to patients with cancer that their journey is not short term?  

The Right-to-Try law, which has been in effect since May 2018, may have a misleading name, given that it doesn’t require drug manufacturers to grant access to experimental treatments that have passed phase I trials to any patient who seeks it. Rather, the law grants terminally ill patients the “right to ask” the drug company directly, but the request can be denied for several reasons (e.g., limited supply, expense).

When physician-assisted death mandates were passed in states like Oregon, Washington, and California, guidelines were established for practitioners as part of election mandates. However, in states like Montana and Vermont, the legalization of assisted death went through the legislature without process and practice guidelines. Therefore, practitioners have little or no framework to implement the process of medical aid in dying.

Despite groundbreaking treatments, novel medications, fast-tracked drug approvals, and cutting-edge science, a terminal diagnosis is still a reality for many patients with cancer. Having end-of-life discussions with patients and their family members is a difficult part of oncology nursing, but it’s necessary to provide the highest quality of care and education possible. With more news reports emerging about states introducing—and passing—medical aid in dying legislation, oncology nurses will face questions about the process from patients and caregivers.

Daniel is a 55-year-old male diagnosed with stage III nasopharyngeal cancer. He lives with Jon, his partner of 4 years. One day, he is taken by ambulance to the ED where it is determined he had an ischemic stroke. He has no advanced directives or living relatives. What would you do?