Treatment priorities in oncology: do we want to live longer or better?

Abstract

OBJECTIVES:Despite the progress achieved in the fight against cancer over the past several years, assessing the needs, goals and preferences of patients with cancer is of the utmost importance for the delivery of health care. We sought to assess priorities regarding quantity versus quality of life among Brazilian patients, comparing them with individuals without cancer.METHODS:Using a questionnaire presenting four hypothetical cancer cases, we interviewed cancer patients, oncology health-care professionals and laypersons, most of whom had administrative functions in our hospital.RESULTS:A total of 214 individuals participated: 101 patients, 44 health-care professionals and 69 laypersons. The mean ages in the three groups were 56, 34 and 31 years old, respectively (p<0.001). The patients had gastrointestinal (25%), breast (22%), hematologic (10%), lung (8%) or other tumors (36%) and the tumor-node- metastasis (TNM) stage was I, II, III or IV in 22%, 13%, 34% and 31% of cases, respectively. Treatment priorities differed significantly among the three groups (p = 0.005), with survival time being a higher priority for patients than for the other two groups and with opposite trends regarding quality of life. In multivariate analysis, the age and sex distributions were not associated with the choice to maximize quality of life. In this limited sample of cancer patients, there were no associations between treatment priorities and disease stages.CONCLUSIONS:Both survival time and quality of life appeared to be important to cancer patients, oncology health-care professionals and laypersons, but survival time seemed to have higher priority for people diagnosed with cancer than for healthy people. Additionally, survival seemed to be more important than quality of life for all three groups assessed.

Quality of life versus length of life considerations in cancer patients: A systematic literature review

“…Although some patients opted for treatment initially, they expressed the view that if it was affecting their QoL, they would cease treatment . Marta and colleagues noted that the majority of patients in their study wanted to undergo a treatment that would prolong life but not compromise their QoL . In a qualitative study by Gerber and colleagues, patients stated that they were keen to maintain their activities and not be a burden on family, and therefore not undergo chemotherapy if those factors were compromised, indicating the importance of QoL …”

“…The Quality/Quantity Questionnaire designed by Stiggelbout and colleagues was created to assess patients' preferences toward either QoL or LoL when deciding about cancer treatments . Other methods include discrete choice experiments and various bespoke questionnaires tailored to a specific study …”

“…7 Other methods include discrete choice experiments and various bespoke questionnaires tailored to a specific study. [13][14][15] The aim of this review was to determine the factors influencing patient preferences for either QoL or LoL and how these impacts on cancer treatment choices. A study was only included if there was reference made to preference for QoL or LoL with or without determinants that may influence treatment choice.…”

Medical students writing on death, dying and palliative care: a qualitative analysis of reflective essays

“…The first was to explore how medical students learn about and deal with death, dying and palliative care during and after a clinical placement. Caring for people with a terminal illness is an area that many students were passionate about but struggled with the balance of ‘cure’ against quality, and the relative importance of these for the patient and their family; this is also an issue for doctors 38 39. Students learn from seeing doctors in these situations especially as many will not have come across dying and death before.…”

Patient‐reported outcomes enhance understanding of the impact of pazopanib in soft tissue sarcoma

“…There is considerable evidence demonstrating that patients—and particularly those with advanced disease—are willing to accept considerable toxicity for only modest gains in life expectancy or other health outcomes . In particular, 2 studies investigated the tradeoff patients with renal cancer would be willing to make between toxicity and PFS.…”