Palliative chemotherapy preferences and factors that influence patient choice in incurable advanced cancer

To determine the extent of informed decision-making and treatment preference of Korean patients receiving palliative chemotherapy.

We assessed 138 patients (median age: 58 years; 73% male) with advanced cancer who had received at least one cycle of chemotherapy. General demographic information, the extent of information received, patient preferences for palliative chemotherapy and randomized trials were determined using structured patient interviews. We investigated the survival threshold for justifying toxicity, the factors influencing individual preference for chemotherapy and the attitude of patients towards randomized trials.

Before chemotherapy, 72.1% of patients were given information about adverse events of treatment, but only 39.5% were told of alternative treatments. There was significant inter-individual variability in willingness to accept chemotherapy, as well as a wide range of thresholds. Patients reporting higher quality of life were more likely to judge treatment as acceptable. When given the choice for randomization for conventional chemotherapy, investigational agents or supportive care, patients usually refused enrollment into randomized trials.

Self-assessed quality of life was a significant predictor of stronger preference for chemotherapy. In the palliative setting, good doctor-patient communications and consideration of patients' preferences are necessary for making decisions about proper treatment.