Treatment choices in advanced cancer: issues and perspectives

Treatment choices are difficult in advanced cancer, a disease in which there is little chance of a cure and in which the aim of treatment is usually to achieve palliation. With the clinical evidence and quality-of-life instruments currently available, it may be difficult to decide whether the burdens of cytotoxic chemotherapy are outweighed by its benefits. However, in some cancers, such as advanced colorectal cancer, there is evidence to demonstrate that chemotherapy is justified, with overall benefit to the patient. There are, nevertheless, many factors to be considered in the selection of the best possible care for each patient. These include the availability of new treatments with improved tolerability profiles, resource implications, quality of life and survival benefits (and how to assess them), the willingness or otherwise of patients to undergo chemotherapy, and information and participation preferences among patients. The differing attitudes of health care professionals and groups of patients add to the complexity of this issue. Guidelines offer one way of promoting the consistent and optimal management of patients with advanced cancer; however, individual patient choice will always take precedence over guidelines which, by definition, are devised with common needs in mind.