What do oncologists say about chemotherapy at the very end of life? Results from a semiqualitative survey.
OBJECTIVE
This study elicited oncologists' insights into published statistics that 20% of cancer patients receive chemotherapy within 2 weeks of death and that the median survival between chemotherapy administration and death is 37 days.


METHODS
A semiqualitative survey was developed to enable respondents to provide anonymous, write-in comments on the statistics above. This survey was sent electronically on two separate occasions to oncologists in the upper midwestern United States. Qualitative methods were used to analyze data.


RESULTS
A total of 422 oncology health-care providers were sent the survey, and 61 responded. Nine themes emerged: 1) these decisions are strongly patient-driven; 2) newer agents are driving the decision to continue with cancer treatment; 3) financial incentives on the part of the medical community explain these high rates; 4) health-care reform is necessary; 5) even a small chance of patient benefit justifies this practice; 6) this practice is detrimental to patients because it precludes the initiation of hospice services; 7) others may be prescribing in this manner, but "not us"; 8) these issues are complicated, revolve around society values, and the oncologist alone cannot claim responsibility for such high rates of chemotherapy administration; and 9) there exist barriers to end-of-life discussions.


CONCLUSIONS
Many oncologists are in fact reluctant to prescribe chemotherapy at the end of life, and the complexity of this topic underscores the potential for oncologists and palliative care providers to collaborate in an effort to provide cancer patients the best care at the very end of life.
Behl
Deepti
D
Department of Oncology, Mayo Clinic, Rochester, Minnesota 55905, USA.
Jatoi
Aminah
A
D000328:Adult; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000191:economics; D001291:Attitude of Health Personnel; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D018447:Medical Futility; D008495:Medical Oncology / Q000191:economics / Q000379:methods* / Q000592:standards; D008875:Middle Aged; D015146:Midwestern United States; D009369:Neoplasms / Q000188:drug therapy* / Q000191:economics; D010166:Palliative Care / Q000379:methods* / Q000592:standards; D057240:Patient Preference; D036301:Qualitative Research; D013727:Terminal Care / Q000191:economics / Q000379:methods* / Q000592:standards
D000970:Antineoplastic Agents