Skip to content

Death with Dignity: Brittany Maynard

November 3, 2014

OLYMPUS DIGITAL CAMERA

Brittany Maynard had been diagnosed with stage 4 glioblastoma last spring and was told she likely had 6 months to live; so she chose to die yesterday, surrounded by family and friends via the state of Oregon’s “Death with Dignity Act,” which allows terminally-ill Oregonians to end their lives through the voluntary self-administration of lethal medications, expressly prescribed by a physician for that purpose.1 This is not a new law, but many people are now paying attention to it, due to Brittany’s awareness campaign. Brittany was 29 years old.

Brain tumors are not common, and occur in about 6 in 100,000 people in the US per year, with 4 of those 6 dying from those tumors. Of these, about 1/3 fall into the category of either glial cell tumors, anaplastic astrocytoma and glioblastoma.2 The standard-of-care treatment for patients with newly diagnosed glioblastoma is surgery followed by concurrent radiation therapy and daily temozolomide, and then followed by six cycles of temozolomide.3

Brittany did have surgery, but decided not to have chemotherapy nor did she have radiation. After doing the research, she knew that the 5 year survival could be as low as 10% for patients with stage 4 glioblastoma.4 She knew that she would not have children, or live to see those children grow up. She wanted to spend the time she had with her husband and family, and achieve some personal goals she had set for herself. She also expressed the desire to “die with dignity.”

This regimen is based largely on a clinical trial that was published in the New England Journal of Medicine in 2005.5 The median survival for the above regimen (the time at which half the patients who started patients were still alive since the beginning of the trial), was 14.6 months. There was no placebo, so it is hard to compare to those with no treatment, but fair to say it is most probably less, based on historical data. There is no way to say exactly how much time the regimen would have added to Brittany’s life, but it would most likely have been months, not years.

Side effects due to temozolomide seen in the clinical study were such on the blood (low red and white blood cells, and platelets) that a patient might need to spend time in the hospital, making them susceptible to infections and fatigue.
Side effects of radiation include fatigue, sores in your mouth, and hair loss, among others.6 For a young woman interested in going to Alaska, Olympic National Park, Yellowstone, and the Grand Canyon, side effects like these would likely have prevented her from achieving these final goals in her life.

The closing remarks of the clinical study are interesting- authors state that “temozolomide and radiotherapy provide a statistically and clinically meaningful survival benefit.” Quite clearly, Brittany Maynard and her family did not agree.

1. Oregon.gov. Death with Dignity Act. Accessed Nov 3, 2014. http://public.health.oregon.gov/ProviderPartnerResources/EvaluationResearch/DeathwithDignityAct/Pages/index.aspx

2. National Cancer Institute. General Information About Adult Brain Tumors. Accessed Nov 3, 2014 from
http://www.cancer.gov/cancertopics/pdq/treatment/adultbrain/HealthProfessional/page1

3. National Cancer Institute. Management of Specific Tumor Types and Locations. Accessed Nov 3, 2014 from
http://www.cancer.gov/cancertopics/pdq/treatment/adultbrain/HealthProfessional/page4#Section_815.

4. UCLA. Neuro-oncology. How Our Patients Perform : Glioblastoma Multiforme [GBM]. Accessed Nov 3, 2014.
http://www.neurooncology.ucla.edu/performance/glioblastomamultiforme.aspx

5. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus Concomitant
and Adjuvant Temozolomide for Glioblastoma. N Eng J Med. 2005;352:987-96.

6. National Cancer Institute. Radiation Therapy Side Effects. Accessed Nov 3, 2014 from http://www.cancer.gov/cancertopics/coping/radiation-therapy-and-yo

Advertisements
Leave a Comment

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: