Abstract
ObjectiveTo explore the extent to which patients have a directing role in decisions about chemotherapy in the palliative phase of cancer and (want to) anticipate on the last stage of life.DesignQualitative interview study.MethodsIn depth-interviews with 15 patients with advanced colorectal or breast cancer at the medical oncology department in a Dutch teaching hospital; interviews were analysed following the principles of thematic content-analysis.ResultsAll patients reported to know that the chemotherapy they received was with palliative intent. Most of them did not express the wish for information about (other) treatment options and put great trust in their physicians’ treatment advice. The more patients were aware of the severity of their disease, the more they seemed to ‘live their life’ in the present and enjoy things besides having cancer. Such living in the present seemed to be facilitated by the use of chemotherapy. Patients often considered the ‘chemotherapy-free period’ more stressful than periods when receiving chemotherapy despite their generally improved physical condition. Chemotherapy (regardless of side-effects) seemed to shift patients’ attention away from the approaching last stage of life. Interestingly, although patients often discussed advance care planning, they were reluctant to bring on end-of-life issues that bothered them at that specific moment. Expressing real interest in people ‘as a person’ was considered an important element of appropriate care.ConclusionsFearing their approaching death, patients deliberately focus on living in the present. Active (chemotherapy) treatment facilitates this focus, regardless of the perceived side-effects. However, if anxiety for what lies ahead is the underlying reason for treatment, efforts should be made in assisting patients to find other ways to cope with this fear. Simultaneously, such an approach may reduce the use of burdensome and sometimes costly treatment in the last stage of life.
Highlights
Major advances in the treatment of cancer characterize the past two decades
With this study we aimed to explore a) the extent to which patients with potentially chemotherapy responsive tumours have a directing role in decisions about second- and third-line chemotherapy in the palliative phase of cancer and b) already anticipate on the last stage of life
In the present study we interviewed patients with advanced colorectal and breast cancer who had received at least one previous line of chemotherapy in the palliative phase of the disease
Summary
Major advances in the treatment of cancer characterize the past two decades. An increasing number of treatment options (chemotherapy, endocrine therapy, targeted therapy) in the palliative phase of cancer have become available; some with improved tolerability and available to more general use in cancer patients, for those in relatively poor condition [1]. Surviving well beyond 2–3 years after diagnosis of advanced disease in chemotherapy responsive tumors (e.g. breast- or colorectal cancer) has become the rule rather than the exception [2,3]. Second and third line chemotherapy in many malignancies have a limited likelihood of response and only modest improvement in (progression-free) survival, if any [7]. Treatment advances have confronted physicians with dilemmas concerning the appropriateness of (further) treatment
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