Nanni O.,Unita Operativa di Biostatistica e Sperimentazioni Cliniche |
Scarpi E.,Unita Operativa di Biostatistica e Sperimentazioni Cliniche
Journal of Medicine and the Person | Year: 2010
The appropriate role of antitumour therapies in far advanced cancer patients is a complex issue and the switch to best supportive care alone is often a difficult choice as there are no international guidelines on the minimum amount of benefit needed to justify the use of palliative chemotherapy. New chemotherapeutic drugs with well-tolerated toxic profiles are increasingly available and patients' expectations often influence physicians to continue chemotherapy in the absence of a clear appropriateness principle, even when death is approaching. Recruitment in phase I studies is an opportunity to offer a potential, albeit rare, benefit when no other therapeutic options are available. Although communication and understanding between the physician, patient and family is pivotal to avoid futile care in cancer, modern clinicians often find themselves in difficulty when having to inform patients about a poor prognosis, mainly because they are all too aware of the poor accuracy of predictions about lifeexpectancy. Several tools on prognosis prediction are now available to help physicians discriminate between patients who could benefit from palliative chemotherapy and those for whom supportive and palliative approaches would be more suitable. It has also been seen that the management of patients with far advanced cancers is improved by close collaboration between palliative care experts and oncologists. © Springer-Verlag 2010.