Towards a novel approach guiding the decision-making process for anticancer treatment in patients with advanced cancer: framework for systemic anticancer treatment with palliative intent
- Patient-centered decisions in advanced cancer care demand a step-wise decisional process, not a single decision act.
- The decision process includes key palliative care domains, e.g. illness understanding, symptom control, or end-of-life preparation.
- Patients' attitudes, beliefs, hopes, patient-physician interaction, and physician attitudes demand structured observation.
- The SACT-PI Decision Framework includes concrete steps: assess, educate, verify, reflect, discuss, weigh, pause, decide.
- Inter-professionally working oncology clinicians may transform decision-making processes in oncology beyond decision aids.
Oncologists typically base treatment recommendations on survival, tumor control, and toxicity data from high-quality clinical trials.¹ In patients with resistant tumors and in unfit patients, anticancer treatment is often applied even without sufficient supporting evidence. Many patients may face toxicity with modest benefit from such treatments,² whereas, in others, a systemic anticancer treatment with palliative intent (SACT-PI) may alleviate cancer-related symptoms.³,⁴
In modern oncology, patients with advanced disease often face uncertainty⁵ and may have inaccurate perceptions of their prognosis⁶,⁷ and treatment goals.⁸ Moreover, they may have difficulties weighing the toxicity risk against potential benefits in terms of symptom control and quality of life.⁹ These factors can compromise informed decision-making and may contribute to so-called aggressive end-of-life care.¹⁰ An individualized decision process¹¹ becomes increasingly important to address palliative care (PC) domains like multidimensional symptom burden, illness and prognosis understanding,¹² spirituality,¹³ life closure,¹⁴ or family involvement.¹⁵
Current evidence suggests that non-medical factors like attitudes, values and beliefs, sociodemographic variables such as (young) age, and aspects of the physician-patient relationship may influence SACT decisions.¹⁶ Current evidence to guide oncologists’ decision-making for or against SACT-PI is rare.
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