Who wants second-line, palliative chemotherapy?

This paper reports on a study designed to measure the value attached to second-line, palliative chemotherapy by people with advanced cancer, compared with the value healthy people assume they would attach if they had cancer and to assess reasons for accepting or declining treatment. Subjects comprised 92 people with cancer, 76 healthy control subjects, 60 medical oncologists, 128 clinical oncologists, 72 palliative care physicians, 58 general practitioners and 59 qualified nurses working within oncology. Using a questionnaire presenting two typical but imaginary treatment scenarios, subjects indicated whether treatment would be acceptable to them and, if so, what minimum chance and duration of benefit would make treatment worthwhile. Demographic and social data were also collected. Patients accepted a lower chance of benefit than all other groups. Although the minimum worthwhile duration of benefit was more evenly spread, patients choosing lower time values were over-represented. These results were consistent even when treatment involved greater toxicity. The conclusion drawn from this study is that people with advanced cancer are more willing to accept second-line chemotherapy with a lower chance and shorter duration of benefit than others may imagine. Health care professionals must recognize this when discussing treatment options with patients.