Patients with Advanced Cancer Willing To Accept Riskier Chemotherapy

People with advanced cancer are more willing than healthy people or doctors to consider a toxic chemotherapy regimen even if it offers only a minimal chance of slowing their cancer, according to a new study.

The findings, published in the journal Psycho-Oncology, suggest that cancer patients who have failed to respond to the most effective chemotherapy, known as first-line treatment, and healthy people share very different views of "worthwhile" treatment.

The researchers say the study illuminates an important consumer viewpoint that should be considered by decision-makers and policy-makers when planning health care services and allocating resources.

"Many people with advanced cancer seem to feel it is worthwhile undergoing treatment, even if that treatment means reduced quality of life and the possibility of minimal benefit," says the lead investigator, Claire E. Balmer, R.N. of the Dorset Cancer Centre in Great Britain.

The researchers asked 92 people with cancer, 76 healthy people without cancer, 260 oncologists and palliative care physicians, 59 oncology and palliative care nurses and 58 general practitioners to consider two second-line treatment scenarios. One scenario involved brief, intravenous treatment in an outpatient setting and the other involved a more intensive, three-day treatment regimen that would cause more severe side effects.

The subjects were asked whether each treatment would be acceptable to them, given stated side effects and risks. They also were asked to choose the minimum chance of benefit and minimum duration of the benefit they would accept to make each form of treatment worthwhile for them.

Compared to the healthy people, physicians and nurses, the cancer patients generally were more willing to accept both the milder and riskier chemotherapy, even if the chance of remission was low and of short duration.

"These results suggest that physicians and other health care professionals may want to reconsider their definitions of ‘worthwhile' when discussing treatment options with patients," she says.

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Psycho-Oncology is a bimonthly international journal devoted to the psychological, social and behavioral dimensions of cancer. Published by John Wiley, it is the official journal of the American, British and International Psycho-Oncology Societies. Contact Jimmie Holland, M.D., Co-Editor, at (212) 739-7051 for information. For copies of the article, contact the Center for the Advancement of Health at 202.387.2829 or e-mail press@cfah.org