Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public.

Slevin, M. L.; Stubbs, Laura; Plant, Hilary; Wilson, Peter; Gregory, WM; Armes, Patti; Downer, S M

doi:10.1136/bmj.300.6737.1458

Cited by 710 publications

(376 citation statements)

References 6 publications

Supporting

Mentioning

334

Contrasting

Unclassified

Order By: Relevance

“…However, in a study based on hypothetical treatment scenarios, patients with cancer who were about to undergo chemotherapy were asked to balance the price they would be prepared to pay in terms of side-effects for a particular degree of benefit. About half of patients reported they would accept intensive toxic chemotherapy for minimal benefit in terms of survival, prolongation of life or relief of symptoms (Slevin et al, 1990). This is a hypothesis-generating study.…”

Section: Discussionmentioning

confidence: 96%

Do patients with advanced breast cancer benefit from chemotherapy?

Ramirez¹,

Towlson²,

Leaning³

et al. 1998

Br J Cancer

View full text Add to dashboard Cite

Summary This study aimed to assess the proportion of patients with advanced breast cancer who report benefit from first-line palliative chemotherapy using a simple global measure of wellbeing and to identify factors predicting benefit. A consecutive series of women with advanced breast cancer undergoing first-line palliative chemotherapy was evaluated. The main outcome measure was patient report of overall wellbeing assessed at post-treatment interview. Physical, psychological and functional status were assessed using the Rotterdam Symptom Checklist (RSCL) on three occasions (pretreatment, at the start of the third cycle and post treatment). It was planned that treatment would be discontinued after six cycles (i.e. 18-24 weeks). One hundred and sixty patients started treatment, of whom 155 were assessable for quality of life. After treatment, 41 (26%) patients reported they felt better, 29 (19%) felt the same and 34 (22%) felt worse than they did before treatment. The other 51 (33%) patients either died or stopped attending the hospital before the post-treatment interview and were assigned as treatment 'failures'. Patients who reported feeling better after treatment had improvements in psychological distress (P < 0.0001), pain (P = 0.01), lack of energy (P = 0.02) and tiredness (P = 0.02), as well as improvement in functional status (P = 0.07). Feeling better was also correlated with disease response (P = 0.03). Feeling worse after treatment or treatment 'failure' was predicted by the pretreatment presence of a dry mouth (P = 0.003) and high levels of psychological distress (P = 0.03). Pretreatment lack of energy (P = 0.01), dry mouth (P = 0.02), presence of liver metastases (P = 0.03) and breathlessness (P = 0.03) predicted treatment 'failures'. The results of this study suggest that first-line palliative chemotherapy for advanced breast cancer confers benefit on a substantial proportion of patients, with about one-quarter feeling better after treatment and nearly a half feeling better or the same some 4-6 months after the start of treatment. Factors identified in this study may assist clinicians in deciding which patients should not be offered treatment, because of high risk of feeling worse or treatment 'failure'. This work now needs to be validated on a further cohort of women receiving chemotherapy for advanced breast cancer.

show abstract

Section: Discussionmentioning

confidence: 96%

Do patients with advanced breast cancer benefit from chemotherapy?

Ramirez¹,

Towlson²,

Leaning³

et al. 1998

Br J Cancer

View full text Add to dashboard Cite

show abstract

“…We observed similar findings in that most patients rated highly the possibility of personal benefit. Slevin et al (1990) found that patients with cancer are willing to accept treatment with cytotoxics for lower chances of benefit than those thought acceptable by their physicians or nurses.…”

Section: Discussionmentioning

confidence: 99%

Patient motivations surrounding participation in phase I and phase II clinical trials of cancer chemotherapy

et al. 2005

View full text Add to dashboard Cite

Successful advances in the treatment of advanced malignant diseases rely on recruitment of patients into clinical trials of novel agents. However, there is a genuine concern for the welfare of individual patients. The aim of this study was to examine motives of patients entering early clinical trials of novel cancer therapies. Questionnaire survey with both open- and close-ended questions. The patients were surveyed after they had given informed consent and before or during the first cycle of treatment. In all, 38 phase I/II trial patients participated and completed the survey. Obtaining possible health benefit was listed by 89% as being a ‘very important' factor in their decision to participate, with only 17% giving reasons of helping future cancer patients and treatment. Other items cited as a ‘very important' motivating factor were ‘trust in the doctor' (66%), ‘being treated by the latest treatment available' (66%), ‘better standard of care and closer follow-up' (61%), and ‘closer monitoring of patients in trials' (58%). Only 47% patients indicated that someone had explained to them about any ‘reasonable' alternatives to the trial. In total, 71% strongly agreed that ‘surviving for as long time as possible was the most important thing (for them)'. Nearly all (97%) indicated that they knew the purpose of the trial and had enough time to consider participation in the trial (100%). In this survey, most patients entering phase I and II clinical trials felt they understood the purpose of the research and had given truly informed consent. Despite this, most patients participated in the hope of therapeutic benefit, although this is known to be a rare outcome in this patient subset. Trialists should be aware, and take account of the expectations that participants place in trial drugs.

show abstract

“…All patients will experience the side effects, but only some patients will actually benefit from this treatment. Patients' preferences regarding this trade-off have shown to vary widely (e.g., Jansen et al, 2001) and to differ from the preferences of doctors (e.g., Slevin et al, 1990). Charles et al (1997) stress the importance of shared decision-making in the case of adjuvant chemotherapy, because: (1) several treatment options exist with different possible outcomes and substantial uncertainty, (2) there is often no clear-cut right or wrong answer and (3) the impact of the treatment on the patient's physical and psychological well being will vary.…”

mentioning

confidence: 99%