“Rather one more chemo than one less…”: Oncologists and Oncology Nurses’ Reasons for Aggressive Treatment of Young Adults with Advanced Cancer

Laryionava, Katsiaryna; Heußner, Pia; Hiddemann, Wolfgang; Winkler, Eva C.

doi:10.1634/theoncologist.2017-0094

Cited by 18 publications

(25 citation statements)

References 42 publications

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“…Continuation of treatment until close to death was considered a major contributor to hospital death in our study, though often perceived as unavoidable, particularly in younger patients receiving intensive chemotherapy for aggressive disease. Administration of treatment close to death is considered overly aggressive by some ( Beaussant et al, 2018 ; Hui et al, 2014 ), but may be due to haematologists’ concerns that the potential for cure still exists (even in advanced disease), the availability of multiple and/or new lines of treatment and difficulty identifying refractory disease and the end of life phase ( Hui et al, 2015 ; McCaughan et al, 2017 ; Odejide et al, 2014 ); it may also be based on often unrealistic hope for response or cure, driven by patients and clinicians, as described in our own study and elsewhere ( Laryionava et al, 2018 ; Odejide et al, 2016 ).…”

Section: Discussionmentioning

confidence: 96%

Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study

McCaughan

Roman

Smith

et al. 2019

European Journal of Oncology Nursing

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PurposePatients with haematological malignancies are more likely to die in hospital, and less likely to access palliative care than people with other cancers, though the reasons for this are not well understood. The purpose of our study was to explore haematology nurses' perspectives of their patients’ places of care and death.MethodQualitative description, based on thematic content analysis. Eight haematology nurses working in secondary and tertiary hospital settings were purposively selected and interviewed. Transcriptions were coded and analysed for themes using a mainly inductive, cross-comparative approach.ResultsFive inter-related factors were identified as contributing to the likelihood of patients’ receiving end of life care/dying in hospital: the complex nature of haematological diseases and their treatment; close clinician-patient bonds; delays to end of life discussions; lack of integration between haematology and palliative care services; and barriers to death at home.ConclusionsHospital death is often determined by the characteristics of the cancer and type of treatment. Prognostication is complex across subtypes and hospital death perceived as unavoidable, and sometimes the preferred option. Earlier, frank conversations that focus on realistic outcomes, closer integration of palliative care and haematology services, better communication across the secondary/primary care interface, and an increase in out-of-hours nursing support could improve end of life care and facilitate death at home or in hospice, when preferred.

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Section: Discussionmentioning

confidence: 96%

Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study

McCaughan

Roman

Smith

et al. 2019

European Journal of Oncology Nursing

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“…This proximity intensified the sense of tragedy because of memories HCPs possess of their own younger years or their children's young adulthood and reflects countertransference, a theory that has been used to explain why HCPs may be more inclined to administer tumor-directed therapy to AYAs close to death. 22 Countertransference describes how certain emotional and behavioral reactions from HCPs toward their patients originate from previous life experiences. 23 In our study, participant reactions to their AYA patients may have originated from their own experiences as young adults or as parents of young adults.…”

Section: Discussionmentioning

confidence: 99%

“It’s More Difficult…”: Clinicians’ Experience Providing Palliative Care to Adolescents and Young Adults Diagnosed With Advanced Cancer

Avery

Geist

D’Agostino

et al. 2020

JCO Oncology Practice

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PURPOSE: Adolescents and young adults (AYAs; age 15-39 years) with advanced cancer are a population in whom quality of life is uniquely affected because of their stage of life. However, training focused on palliative care for AYAs is not routinely provided for health care providers (HCPs) in oncology. This study aims to explore the experiences of HCPs involved in introducing and providing palliative care caring for AYAs with advanced cancer and their families to understand the unique challenges HCPs experience. METHODS: Using a qualitative descriptive design, semistructured interviews were conducted with medical and radiation oncologists, palliative care physicians, psychiatrists, and advanced practice nurses involved in caring for AYAs diagnosed with advanced cancer (N = 19). Interviews were transcribed verbatim and analyzed using thematic analysis in combination with constant comparative analysis and theoretical sampling. RESULTS: There were 19 participants, 9 men and 10 women, with a median age of 45 years (range, 24-67 years). Six were palliative care physicians, 5 medical oncologists, 4 nurse practitioners, and 2 each radiation oncologists and psychiatrists. Overall, participants perceived the provision of palliative care for AYAs to be more difficult compared with older adults. Four themes emerged: (1) challenges helping AYAs/families to engage in and accept palliative care, (2) uncertainty regarding how to involve the family, (3) HCP sense of tragedy, and (4) HCP sense of emotional proximity. CONCLUSION: Findings from this study support the development of dedicated training for HCPs involved in palliative care for AYA.

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“…Intensive treatment is more common among younger patients with cancer, which may be driven by the injustice of death at a young age. 30,31 Many participants considered QoL to be more important than LoL, and two-thirds of elderly patients (aged !65 years) indicated that QoL was at least equally as important as LoL. This finding is particularly important for designing clinical trials in advanced STS, where QoL could be considered as a (co)primary or composite endpoint.…”

Section: Discussionmentioning

confidence: 99%

Priorities and preferences of advanced soft tissue sarcoma patients starting palliative chemotherapy: baseline results from the HOLISTIC study

et al. 2021

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Available online xxxIntroduction: Palliative chemotherapy is the principal treatment of patients with advanced soft tissue sarcomas (STS); however prognosis is limited (median overall survival 12-19 months). In this setting, patient values and priorities are central to personalised treatment decisions. Patients and methods: The prospective HOLISTIC study was conducted in the UK and the Netherlands assessing healthrelated quality of life in STS patients receiving palliative chemotherapy. Participants completed a questionnaire before starting chemotherapy, including attitudes towards quality of life (QoL) versus length of life (LoL), decisional control preferences, and decisional conflict. Chi-square and Fisher's exact tests were used to evaluate associations between patient characteristics and preferences. Results: One hundred and thirty-seven patients with advanced STS participated (UK: n ¼ 72, the Netherlands: n ¼ 65). Median age was 62 (27-79) years. Preference for extended LoL (n ¼ 66, 48%) was slightly more common than preference for QoL (n ¼ 56, 41%); 12 patients (9%) valued LoL and QoL equally (missing: n ¼ 3). Younger patients (age <40 years) prioritised LoL, whereas two-thirds of older patients (aged !65 years) felt that QoL was equally or more important than LoL (P ¼ 0.020). Decisional conflict was most common in patients who prioritised QoL (P ¼ 0.024). Most patients preferred an active (n ¼ 45, 33%) or collaborative (n ¼ 59, 44%) role in treatment decisions. Gender, performance status, and country were significantly associated with preferred role. Concordance between preferred and actual role in chemotherapy decision was high (n ¼ 104, 76%). Conclusions: Heterogeneous priorities and preferences among advanced STS patients support personalised decisions about palliative treatment. Considering individual differences during treatment discussions may enhance communication and optimise patient-centred care.

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“Rather one more chemo than one less…”: Oncologists and Oncology Nurses’ Reasons for Aggressive Treatment of Young Adults with Advanced Cancer

Cited by 18 publications

References 42 publications

Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study

Haematology nurses' perspectives of their patients' places of care and death: A UK qualitative interview study

“It’s More Difficult…”: Clinicians’ Experience Providing Palliative Care to Adolescents and Young Adults Diagnosed With Advanced Cancer

Priorities and preferences of advanced soft tissue sarcoma patients starting palliative chemotherapy: baseline results from the HOLISTIC study

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