Starting and stopping palliative tumour treatment: considerations in the context of quality of life and costs
Vreugdenhil, G.A.; van den Beuken-van Everdingen, M.H.J.M.
Nederlands Tijdschrift Voor Geneeskunde 159: A8729
2015
ISSN/ISBN: 1876-8784 PMID: 26131748 Document Number: 682616
Although palliative treatment options are increasing, more emphasis is required on benefits and quality of life, in view of rising costs. Few studies have focused on factors determining decisions regarding treatment choices. The dilemma may involve generally expected patient attitudes such as never giving up on the one hand and limitations in potential and adverse events on the other. WHO performance status, type of cancer and comorbidity influence oncologists' decisions, but many other factors which have not yet been clearly identified may also be involved. Shared decision-making is poorly studied in the palliative setting. Active treatment is most frequently promoted, rather than best supportive care. Patients sometimes feel insufficiently informed. Quality adjusted life years assessment may add to decision-making. Involving palliative care expertise, and collaborating with oncologists and general physicians, may be of value regarding decision-making. Introduction of more objective parameters to outweigh benefits and burden of (maintaining) palliative tumour-directed treatment is required.