Oncologists' decisions about administering late chemotherapy: What makes it so difficult?

Minnie Bluhm, PhD, MPH 
Assistant Professor 
College of Health and Human Services, Eastern Michigan University 
Recorded October 28, 2015 

Background: An estimated 20-50% of incurable cancer patients receive chemotherapy in the last 30 days of life, although little data support this practice. Few studies have explored oncologists' rationales for administering late chemotherapy. This study examines factors that oncologists report influence those decisions. Methods: In-depth individual interviews were conducted with 17 oncologists. Interviews were audio-recorded and transcribed. Transcripts were coded and content analyzed. Results: 1) Clinical factors drive oncologists’ decisions when they point to clear treatment choices, along with patient preferences. 2) Late chemotherapy is patient-driven, and used to palliate physical and emotional symptoms, even when physical benefit is not expected. 3) Caring for dying patients is difficult and impacts oncologists and their treatment decisions. Conclusions: Findings begin to explain why it can be so difficult for oncologists to refuse patients late chemotherapy. Doing so adds to the existing burden of caring for dying patients. At times, oncologists prescribe chemotherapy to simply help everyone feel better, regardless of expected clinical benefits or costs. Future work is needed on the impact of caring for dying patients on oncologists and on supportive interventions that promote optimal treatment decisions. 

This lecture was part of the 2015-2016 Bioethics Brownbag & Webinar Series, presented by the Center for Ethics.