Palliative Chemotherapy or Watchful Waiting? A Vignettes Study Among Oncologists

Koedoot, C.G.; Haes, J.C.J.M. de; Heisterkamp, S. H.; Bakker, Piet; Graeff, Alexander de; Haan, Rob J. de

doi:10.1200/jco.2002.12.012

Cited by 52 publications

(28 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Best supportive care is often perceived as 'doing nothing' (Charles et al, 1998). For medical oncologists, the patient's wish is an important determinant of their own preference for treatment (Charles et al, 1998;Koedoot et al, 2002). Moreover, they also prefer to 'do something', that is, offering chemotherapy, rather than offering best supportive care (de Haes and Koedoot, 2003).…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2003

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

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

et al. 2003

View full text Add to dashboard Cite

show abstract

“…These findings are similar to those of a study in the United States, which found that 22% of patients with NSCLC who had already received chemotherapy would choose chemotherapy over best supportive care for a survival benefit of 3 months (10). However, in clinical practice only a small proportion of patients with cancer actually refuse chemotherapy (12). One possible reason for patients' willingness to undergo chemotherapy is that they have overly optimistic expectations of the results of treatment.…”

Section: Discussionmentioning

confidence: 99%

Patients Preferences in Chemotherapy for Advanced Non-small-cell Lung Cancer

et al. 2005

View full text Add to dashboard Cite

Objective To determine how Japanese patients with lung cancer weigh potential survival, chemotherapy response rate, and symptom relief against the potential toxicity of different treatments in cancer chemotherapy. Methods and PatientsWe used a questionnaire describing a hypothetical situation about stage IV nonsmall-cell lung cancer. Seventy-three patients with lung cancer who had received chemotherapy and 120 patients with other respiratory disease as the control group were asked to rate the minimal benefit that would make two hypothetical treatments acceptable. For "chance of cure," "response but not cure," and "symptom relief," the subjects could give answers from 1% to 100% and for prolonging life could give answers from 1 to 60 months.Results Patients with lung cancer were significantly more likely than were patients with other respiratory diseases to accept either intensive or less-intensive treatments for a potentially small benefit for "chance of cure," "response but not cure," and "symptom relief". The degree of survival advantage that patients require before accepting cancer treatment with its associated toxicity varied widely. If their lives were prolonged 3 months, 19% and 21% of patients with lung cancer would choose to receive intensive and less-intensive treatment, respectively. When the chance of symptom relief was 70%, 73% of patients with lung cancer were willing to choose intensive chemotherapy. Factor associated with patients' choice of chemotherapy in both groups was age.Conclusion Oncologists must consider the substantial range of attitudes to chemotherapy among patients when making treatment decisions and they must give patients the opportunity to be included in this process. (Internal Medicine 44: 107-113, 2005)

show abstract

“…Thematic file 16 vignettes cliniques de patients en différentes situations palliatives sont présentées à 697 oncologues devant se déterminer sur le choix d'un traitement spécifi que ou non [33]. L'âge du patient, son désir de poursuivre la chimiothérapie et l'espérance de survie sont les principaux paramètres déterminant le choix thérapeutique.…”

Section: Dossierunclassified

La décision d’arrêt de la chimiothérapie chez les patientes atteintes de cancer du sein métastatique

Bouleuc¹,

Chvetzoff²,

Favier³

et al. 2011

Oncologie

View full text Add to dashboard Cite

La décision d'arrêt de la chimiothérapie chez les patientes atteintes de cancer du sein métastatique Groupe de travail : C. Bouleuc (oncologue-soins palliatifs), G. Chvetzoff (oncologue-soins palliatifs), L. Favier (oncologue médical), I. Krakowski (oncologue médical), P. Poulain (soins palliatifs), C. Tournigand (oncologue médical) La décision d'arrêt d'une chimiothérapie palliative en situation métastatique est un mélange complexe d'enjeux thérapeutiques, humains et éthiques. La qualifi cation même de « palliative » associée à la chimiothérapie fait débat entre les oncologues et les médecins de soins palliatifs. De manière un peu paradoxale, ce sont les oncologues qui revendiquent l'adjectif « palliatif » dès la première ligne de chimiothérapie au stade métastatique (c'est-à-dire dès que le but du traitement est un allongement de la durée de vie, même très prolongé, et/ou de la qualité de vie), alors que les médecins de soins palliatifs le repoussent aux ultimes lignes thérapeutiques. Recommandations GuidelinesFréquence de la prescription de chimiothérapie en fi n de vie La fréquence de la prescription de chimiothérapie palliative en phase terminale n'est pas négligeable. Dans une étude fi nlandaise, 20 % des patientes atteintes de cancer du sein métastatique reçoivent une chimiothérapie dans le dernier mois de vie [2]. Une autre étude effectuée en Amérique du Nord et en Australie retrouve un résultat similaire, 18 % de chimiothérapie dans les quatre dernières semaines et 8 % dans les deux dernières [31]. Dans une autre étude au Portugal, 37 % de patients atteints de tout type de cancer reçoi-vent une chimiothérapie dans le dernier mois de vie, dont 21 % dans les 15 derniers jours [6].

show abstract

Palliative Chemotherapy or Watchful Waiting? A Vignettes Study Among Oncologists

Abstract: Patients will encounter different decisions depending on their oncologists' preferences and their own personal background. Therefore, to ensure adequate information for decision-making processes, decision aids are proposed.

Cited by 52 publications

References 42 publications

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

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

Patients Preferences in Chemotherapy for Advanced Non-small-cell Lung Cancer

La décision d’arrêt de la chimiothérapie chez les patientes atteintes de cancer du sein métastatique

Contact Info

Product

Resources

About