Patients' perspectives on participation in clinical trials and palliative end-of-life care for management of advanced cancers in Nigeria.

Abstract

78 Background: Advanced cancers remain a major cause of mortality in Nigeria. Participation in clinical trials (PCTs) and palliative end-of-life care (PEOLC) are two approaches to incurable cancer management in the developed nations but these have been less adopted in Nigeria. This study set out to determine patients’ preferred approach between PCTs and PEOLC for management of advanced cancers in Nigeria. Methods: A survey of 120 advanced cancer patients was conducted using a questionnaire with 5-point Likert scale, variables of interest included demographic information, knowledge and perception about PCTs and PEOLC. Results: Majority of the patients (84%) agree PCTs is an option in management of incurable cancer but just about half accept it is beneficial and will improve their QOL, as against PEOLC, where all the patients considered it an option and deem it beneficial; with 99% and 98% respectively agreeing it will enhance their QOL and that of family members. About 56% believe PCTs carries a risk of burdensome interventions and 52% increased hospital stay at EOL while 47% are of the opinion it will increase cost of care with 45% stating it will lead to increased ICU death. Sixty-nine percent (69%) and 63% respectively agree PCTs increases the suffering of patients and family members while 43% believe it carries a net negative risk-benefit profile, nevertheless, 83% are ready to overlook the risk of PCTs for possible therapeutic benefit while for 87%, the primary motivation for PCTs is personal cure. Majority (58%) believe PCTs does not improve quality of dying/death contrary to PEOLC where 88% believe it would improve the quality of dying/death. Overall, by direct comparison 78%:13% prefer PEOL to PCTs; {X2(p-value), 40.26(0.001)}. Conclusions: Both modalities are acceptable to advanced cancer patients but the study reveals several ethical issues with PCTs including risk of burdensome interventions, suffering of patients, therapeutic misconception and misperception of curability. A major determinant to accepting PEOL is its positive impact on patients’ QOL. Concerted efforts are needed to significantly enhance access of PEOLC to cancer patients.