ASCO statement: Advanced cancer care should be tailored to patient preferences
Put words in our mouth
Physicians should start an open dialogue about palliative care and treatment with patients as soon as they are identified as having incurable cancer, according to guidelines by the American Society of Clinical Oncology.
Fewer than half of all cancer patients are enrolled in hospice care before their deaths, and of those who are enrolled, one-third are not enrolled until the last week of their lives, according to the policy statement published Jan. 24 in the Journal of Clinical Oncology.
The statement is meant to align patients' personal goals and preferences with realistic conversations about evidence-based medicine, resources and potential outcomes.
The issues addressed include the following:
- Anticancer therapy should be considered only when likely to result in significant clinical benefit. The priority should be placed on enhancing quality of life.Patients should be well informed about their prognosis and treatment options, ensuring that they have opportunities to make their preferences and concerns regarding treatment and supportive care known.Anticancer therapy should be discussed and offered when evidence supports a reasonable chance of providing meaningful clinical benefit.Options to prioritize and enhance patients' quality of life should be discussed when advanced cancer is diagnosed and throughout the course of illness, along with development of a treatment plan that includes goals of therapy.Conversations about anticancer interventions should include information on likelihood of response, the nature of response, and the adverse effects and risks of any therapy. Direct costs related to time, toxicity, loss of alternatives, or financial impacts that can be anticipated should also be discussed to allow patients to make informed choices.Patients with advanced cancer should be given the opportunity to participate in clinical trials or other forms of research.When disease-directed options are exhausted, patients should be encouraged to transition to symptom-directed palliative care alone with the goal of minimizing physical and emotional suffering and ensuring that patients with advanced cancer are given the opportunity to die with dignity and peace of mind.
The statement also recommended raising awareness by:
- emphasizing individualized care in medical education and training (“Quality palliative care should be incorporated into American Board of Internal Medicine training and certification”);recognizing the value of conversations about cancer as well as treatments of cancer (“Programs that use concurrent hospice care and chemotherapy may double the referrals to hospice and reduce end-of-life hospitalizations by more than half”);presenting patient-oriented information from the National Cancer Institute's cancer.gov, ASCO's cancer.net, and patient advocacy group websites to start realistic discussions of care options; andcontinuing basic research in advanced cancer care.