Palliative Chemotherapy and Clinical Trials in Advanced Cancer: The Nurse’s Role

Abstract

Abstract Nurses have always been in the forefront of managing treatment-related symptoms. In an ever-changing and complex health care setting, optimal care requires a transdisciplinary approach. This approach is especially valued in an oncology setting, where patients frequently present with complex disease-and treatment-related symptoms. These often debilitating symptoms negatively affect the quality of life (QOL) of patients and their extended families. For patients with advanced cancer, treatment options are often limited. It is usually at this stage of the cancer continuum that discussion of palliative modalities of treatment occurs. These palliative modalities often include, but are not limited to, radiation, surgery, and chemotherapy. It is also during this stage of the continuum that physicians discuss the use of investigational therapeutic agents as an attempt to control the disease. However, it is not uncommon for patients and families to be faced with difficult decisions. Patients with advanced cancer are often caught between the dichotomy of continuing aggressive treatment and the focus on quality supportive and palliative care. The debate of treatment futility often comes into play at this stage of the cancer continuum, because patients and families are faced with a shorter life expectancy and all standard therapeutic regimens have failed to control the spread and proliferation of the tumor itself. Faced with these difficult decisions, patients and families become especially vulnerable and may experience heightened physical, psychological, social, and spiritual distress.