Treatment strategies in advanced and metastatic cancer: Differences in attitude between the USA, Canada and Europe

Maher, E.J.; Coia, Lawrence R.; Duncan, Graeme; Lawton, P.A.

doi:10.1016/0360-3016(92)90568-3

Cited by 86 publications

(41 citation statements)

References 6 publications

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“…Despite the low-value score assigned to this goal the high SEU score suggested that it would probably be one of the main reasons for prescribing second-line chemotherapy. Previous research has suggested that European oncologists are less likely than their American counterparts to perceive maintenance of hope as an important part of palliative treatments (Maher et al, 1992) and our results suggest that for first-line chemotherapy this may be so.…”

Section: The Goals Of Palliative Chemotherapymentioning

confidence: 42%

Chemotherapy for advanced breast cancer: what influences oncologists’ decision-making?

et al. 2001

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Chemotherapy is widely used in the management of patients with advanced breast cancer. However, a considerable proportion of patients experience toxic side effects without gaining benefit. This study aimed to elicit oncologists' views of the goals of chemotherapy for patients with advanced breast cancer and to elicit which factors are important in decisions to recommend chemotherapy to such patients. 30 oncologists underwent a semi-structured interview to examine their views of 5 goals of chemotherapy and of various disease, treatment and patient-related factors that might influence decisions to offer treatment. The clinicians also made decisions regarding treatment in relation to a hypothetical patient scenario under varying clinical conditions. Relief of symptoms and improvement of activity were rated as the most valuable and achievable goals of treatment. The patient's performance status, frailty and their wishes regarding treatment were the most important patient-related factors in determining decision-making. The most important disease/treatment-related factors were pace of the disease, previous poor response to chemotherapy, co-existing symptoms and concurrent medical conditions. The hypothetical scenario revealed that co-existing medical conditions, adverse previous response, increased age and depression would decrease the likelihood of recommending chemotherapy, whereas key symptoms (e.g. breathlessness) and the patient's goals would increase the likelihood. The findings suggest that British oncologists primarily aim to improve patients' physical function, although subjective factors, such as a patient's desire for anti-cancer treatment and their future goals, also influence decisions to offer treatment. © 2001 Cancer Research Campaign http://www.bjcancer.com

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Section: The Goals Of Palliative Chemotherapymentioning

confidence: 42%

Chemotherapy for advanced breast cancer: what influences oncologists’ decision-making?

et al. 2001

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“…Patients' attitudes and beliefs are thought to be based on previous experience, family, friends, media and other health-care professionals (Richards et al, 1995;Jansen et al, 2001). Doctors' attitudes are influenced by what they think is the aim of the therapy; relief of symptoms, extending life and giving hope (Maher et al, 1992). Several studies have looked at the influence of the way information is presented to patients (McQuellon et al, 1995;Yellen and Cella, 1995;Flood et al, 1996;Mazur and Hickam, 1997;O'Connor, 1998).…”

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confidence: 99%

Palliative chemotherapy or best supportive care? A prospective study explaining patients' treatment preference and choice

et al. 2003

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In palliative cancer treatment, the choice between palliative chemotherapy and best supportive care may be difficult. In the decisionmaking process, giving information as well as patients' values and preferences become important issues. Patients, however, may have a treatment preference before they even meet their medical oncologist. An insight into the patient's decision-making process can support clinicians having to inform their patients. Patients (n ¼ 207) with metastatic cancer, aged 18 years or older, able to speak Dutch, for whom palliative chemotherapy was a treatment option, were eligible for the study. We assessed the following before they consulted their medical oncologist: (1) socio-demographic characteristics, (2) disease-related variables, (3) quality-of-life indices, (4) attitudes and (5) preferences for treatment, information and participation in decision-making. The actual treatment decision, assessed after it had been made, was the main study outcome. Of 207 eligible patients, 140 patients (68%) participated in the study. At baseline, 68% preferred to undergo chemotherapy rather than wait watchfully. Eventually, 78% chose chemotherapy. Treatment preference (odds ratio (OR) ¼ 10.3, confidence interval (CI) 2.8 -38.0) and a deferring style of decision-making (OR ¼ 4.9, CI 1.4 -17.2) best predicted the actual treatment choice. Treatment preference (total explained variance ¼ 38.2%) was predicted, in turn, by patients' striving for length of life (29.5%), less striving for quality of life (6.1%) and experienced control over the cause of disease (2.6%). Patients' actual treatment choice was most strongly predicted by their preconsultation treatment preference. Since treatment preference is positively explained by striving for length of life, and negatively by striving for quality of life, it is questionable whether the purpose of palliative treatment is made clear. This, paradoxically, emphasises the need for further attention to the process of information giving and shared decision-making.

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“…Patterns of practice among radiation oncologists in the treatment of bone metastases Fifteen empirical studies on the patterns of practice of radiation oncologists were identified from 1988 to 2006 [4,9,11,13,15,17,19,25,26,29,32,37,40,46,51].…”

Section: Resultsmentioning

confidence: 99%

Review of patterns of practice and patients’ preferences in the treatment of bone metastases with palliative radiotherapy

Bradley

Husted

Sey

et al. 2006

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Treatment strategies in advanced and metastatic cancer: Differences in attitude between the USA, Canada and Europe

Cited by 86 publications

References 6 publications

Chemotherapy for advanced breast cancer: what influences oncologists’ decision-making?

Chemotherapy for advanced breast cancer: what influences oncologists’ decision-making?

Palliative chemotherapy or best supportive care? A prospective study explaining patients' treatment preference and choice

Review of patterns of practice and patients’ preferences in the treatment of bone metastases with palliative radiotherapy

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