Why Do Patients Choose Chemotherapy Near the End of Life? A Review of the Perspective of Those Facing Death From Cancer

Matsuyama, Robin K.; Reddy, Sashidhar; Smith, Thomas J.

doi:10.1200/jco.2005.03.6236

Cited by 337 publications

(222 citation statements)

References 46 publications

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“…Even the well-informed patient may seek aggressive therapy for small gains despite toxicity, which may also contribute to the increase in aggressive end-of-life care. Our study confirms the findings of Matsuyama et al (2006) that receiving realistic information about prognosis is difficult in the setting of advanced cancer. Despite this, it remains important that patients are well informed about their prognosis and realistic outcomes of available treatments, to ensure that their decisions are in keeping with their personal values.…”

Section: Discussionsupporting

confidence: 81%

“…Although misunderstanding or denial may contribute to this phenomenon, there are alternate explanations. Cancer patients' valuation of therapeutic benefit differs from that of the general population (Matsuyama et al, 2006). Even the well-informed patient may seek aggressive therapy for small gains despite toxicity, which may also contribute to the increase in aggressive end-of-life care.…”

Section: Discussionmentioning

confidence: 97%

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Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

et al. 2008

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We developed a decision aid (DA) for patients with metastatic non-small cell lung cancer (NSCLC), to better inform patients of their prognosis and treatment options, and facilitate involvement in decision-making. In a pilot study, 20 patients with metastatic NSCLC attending outpatient clinics at a major cancer centre, who had already made a treatment decision, reviewed acceptability of the DA. The median age of the patients was 61 years (range 37 -77 years), 35% were male, 20% had a university education, and most (75%) had English as a first language. Most had received chemotherapy, with 65% currently on treatment. Patients were not anxious at baseline and had clear understanding of the goals and toxicity of chemotherapy in advanced NSCLC. After reviewing the DA, patients' anxiety decreased slightly (P ¼ 0.04) and knowledge scores improved by 25% (Po0.001). Most improvements in understanding were of prognosis with and without chemotherapy, although patients still believed advanced NSCLC to be curable. Patients rated the DA highly with respect to information clarity, usefulness and were positive about its use in practice, although 40% found the prognostic information slightly upsetting. The DA for advanced NSCLC is feasible, acceptable to patients and improves understanding of advanced NSCLC without increasing patient anxiety.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 97%

Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

et al. 2008

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“…Indeed, cancer patients are willing to undergo major adverse effects for a small objective benefit to avoid death at any cost [39]. Although chemotherapy use near death is not an acceptable indicator of quality EOL care for all stakeholders, including health care professionals, patients, and family caregivers, the overriding opinion is that patient preferences for treatment should direct chemotherapy use [40].…”

Section: Discussionmentioning

confidence: 99%

“…Although chemotherapy use near death is not an acceptable indicator of quality EOL care for all stakeholders, including health care professionals, patients, and family caregivers, the overriding opinion is that patient preferences for treatment should direct chemotherapy use [40]. With a long-term relationship with terminally ill cancer patients, medical oncologists may be the most cognizant of how hopeful these patients are for small benefits and empathetic with the predicament experienced by desperate patients and families [39,41]. Thus, medical oncologists may agree to provide chemotherapy while patients and families struggle in adjusting to the prognosis.…”

Section: Discussionmentioning

confidence: 99%

Quality of End-of-Life Care Between Medical Oncologists and Other Physician Specialists for Taiwanese Cancer Decedents, 2001–2006

et al. 2009

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After completing this course, the reader will be able to:1. Assess indicators for poor quality end-of-life cancer care in the last month of life.2. Compare the differing perspectives of physicians of various specialties regarding palliative chemotherapy and the use of life-sustaining treatments for terminally ill cancer patients.3. Evaluate the benefits and detriments of administering chemotherapy close to death.This article is available for continuing medical education credit at CME.TheOncologist.com. CME CME ABSTRACTBackground. Oncologists play a significant role in cancer care throughout the cancer trajectory and have traditionally emphasized underuse of procedures/treatments with well-established effectiveness as the source of poor care quality with little attention to overusing end-of-life (EOL) care. The purpose of this populationbased study was to compare the quality of EOL care be-

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“…Studies in the U.S. and internationally show that patients sometimes want cancer treatment that clinicians might not be willing to accept for themselves because of high toxicity and a low probability of benefit [14]. Furthermore, although a patient's prognostic estimate and their desire for aggressive, life-sustaining treatment both decrease as the end of life nears, patients' prognostic estimates are often unrealistically optimistic [15].…”

Section: Understand Patient Preferences and Goals In Order To Inform mentioning

confidence: 99%

Ethical Issues in Patient–Physician Communication About Therapy for Cancer: Professional Responsibilities of the Oncologist

Wenger¹,

Vespa

2010

The Oncologist

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Value in cancer care from a patient-centered perspective not only requires full oncologist-to-patient communication of information about potential treatments, but also imbues in the oncologist a responsibility to evaluate the value of cancer therapies and to offer to patients only those potential therapies that are appropriate for the patient. A case is presented in which the possibility of a low-probability treatment presented without adequate context or advice led to a prolonged, unsatisfying death for a young person with advanced cancer. The professional responsibility of the oncologist includes provision of care based on wise, cost-effective management aimed at meeting the needs of the individual patient. The oncologist has the clinical knowledge, is aware of a patient's clinical details, and has the relationship with the patient that permits understanding his or her values in order to guide cancer care decisions. The oncologist must identify the spectrum of treatments that are indicated for the patient, understand patient preferences and goals in order to inform the patient about options, and advise the patient concerning choice of cancer care. Oncologists as a professional group can ensure the use of standardized outcome measures, promote communication of prognosis and goals in order to guide optimal cancer care choices, and ensure appropriate patient selection and reasonableness in the cost per benefit increment of treatments. In this way, oncologists can ensure value in cancer care. The Oncologist 2010;15(suppl 1): [43][44][45][46][47][48]

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Why Do Patients Choose Chemotherapy Near the End of Life? A Review of the Perspective of Those Facing Death From Cancer

Cited by 337 publications

References 46 publications

Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

Enhancing treatment decision-making: pilot study of a treatment decision aid in stage IV non-small cell lung cancer

Quality of End-of-Life Care Between Medical Oncologists and Other Physician Specialists for Taiwanese Cancer Decedents, 2001–2006

Ethical Issues in Patient–Physician Communication About Therapy for Cancer: Professional Responsibilities of the Oncologist

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