The American Society of Clinical Oncology (ASCO) recently released a policy statement advocating that oncologists engage in candid conversations about prognosis and treatment options with patients suffering from advanced cancer. Published in the January issue of the Journal of Clinical Oncology, the article argues for individualized care entailing realistic conversations not only about prognosis and the risks and benefits of treatments, but also about the patient’s preferences, and his or her perspectives on quality of life. In fact, the authors state that “care intended to enhance patients’ quality of life should be a priority throughout the disease trajectory of advance cancer.” Importantly, the statement makes clear that the option of palliative care should be presented. As the basis for these new recommendations, the authors point to emerging evidence that such conversations take place late in the course of illness or not at all.
In their discussions, the authors refer to studies showing the benefits of palliative care both for patients and their family caregivers. Yet, a preliminary analysis of over 5000 patient records from ASCO’s Quality Oncology Practice Initiative found that only 45% of patients had been enrolled in hospice care before they passed away and of these, one-third became enrolled within a week of their deaths.
The source for and the tenor of the recommendations are refreshing, not least in light of the recent politicization of end of life care conversations as part of the health care reform debates. The hope is now that oncologists will become trained to have such conversations and that they will persevere in the face of objections. At the end of the day the purpose of the recommendations is to reduce suffering among patients and their loved ones.
Please click the journal cover below to be taken to the full article.