title: Is cancer a good way to die? A population-based survey among middle-aged and older adults in the United Kingdom.
abstract: OBJECTIVE
  Despite improved outcomes, cancer remains widely feared, often because of its association with a long and protracted death as opposed to the quick death that people associate with that other common cause of adult mortality: heart disease. Former editor-in-chief of the BMJ Richard Smith's view that 'cancer is the best way to die' therefore attracted much criticism. We examined middle-aged and older adults' agreement with this view and compared their attitudes towards dying from cancer versus heart disease in terms of which was a good death.
  
  
  METHODS
  This study was part of an online survey (February 2015) in a United Kingdom (UK) population sample of 50- to 70-year olds (n = 391), with sampling quotas for gender and education. Five characteristics of 'a good death' were selected from the end-of-life literature. Respondents were asked to rate the importance of each characteristic for their own death to ensure their relevance to a population sample and the likelihood of each for death from cancer and heart disease. We also asked whether they agreed with Smith's view.
  
  
  RESULTS
  At least 95% of respondents considered the selected five characteristics important for their own death. Death from cancer was rated as more likely to provide control over what happens (p < 0.001), control over pain and other symptoms (p < 0.01), time to settle affairs (p < 0.001), and time to say goodbye to loved ones (p < 0.001) compared with death from heart disease, but there were no differences in expectation of living independently until death (p > 0.05). Almost half (40%) agreed that cancer is 'the best way to die', with no differences by age (p = 0.40), gender (p = 0.85), or education (p = 0.27).
  
  
  CONCLUSIONS
  Despite the media commotion, a surprisingly high proportion of middle-aged and older adults viewed cancer as 'the best way to die' and rated cancer death as better than heart disease. Given that one in two of us are likely to be diagnosed with cancer, conversations about a good death from cancer may in a small way mitigate fear of cancer. Future research could explore variations by type of cancer or heart disease and by previous experience of these illnesses in others.
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom. Electronic address: c.vrinten@ucl.ac.uk.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Vrinten
authors.affiliation: Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, United Kingdom.
authors.forename: Jane
authors.initials: J
authors.lastname: Wardle
mesh_terms: D000367:Age Factors; D000368:Aged; D001293:Attitude to Death; D002423:Cause of Death; D004522:Educational Status; D004644:Emotions; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006306:Health Surveys; D006331:Heart Diseases / Q000175:diagnosis / Q000401:mortality*; D006801:Humans; D020407:Internet; D007398:Interpersonal Relations; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000401:mortality*; D059408:Pain Management; D010465:Perception; D011639:Public Opinion; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D006113:United Kingdom / Q000453:epidemiology
keywords: Attitude to death; Cancer; End-of-life; Heart disease; Public perceptions