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What determines the timing of discussions on forgoing anticancer treatment? A national survey of medical oncologists

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Abstract

Purpose

End-of-life discussions (EOLd) including the option of forgoing anticancer treatment infrequently occur until treatment options have been exhausted for advanced cancer patients. We aimed to identify oncologist-related factors contributing to the timing of discussing the option of forgoing anticancer treatment.

Methods

In this nationwide survey of 864 medical oncologists, we asked about physicians’ attitudes toward the timing of discussing the option of forgoing anticancer treatment for a simulated patient with newly diagnosed metastatic cancer, physicians’ experience of EOLd, perceptions of a good death, and beliefs. Multivariate analyses identified determinants of early discussions.

Results

Among 490 physicians (response rate = 57%), 167 (35%) would discuss the option of forgoing anticancer treatment “now (at the diagnosis).” Physicians’ attitudes toward discussing the option “now” were significantly correlated with a greater physician-perceived importance of life completion (odds ratio (OR) = 1.30, 95%CI = 1.00–1.69, p = 0.048) and dying in a preferred place (OR = 1.29, 95%CI = 1.01–1.65, p = 0.045) for a good death, and not perceiving EOLd as being severely distressing for patients/families (OR = 0.70, 95%CI = 0.54–0.95, p = 0.021). In multivariate analyses, independent determinants of the attitude toward discussing the option now included a greater physician-perceived importance of life completion for a good death (OR = 1.38, 95%CI = 1.05–1.81, p = 0.019), and not perceiving EOLd as being severely distressing for patients/families (OR = 0.70, 95%CI = 0.52–0.94, p = 0.017).

Conclusions

Reflection by oncologists on their own perception regarding a good death and beliefs about EOLd may help oncologists individualize the timing of discussing the option of forgoing anticancer treatment.

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Acknowledgments

We would like to thank all the study participants for participating in this survey.

Funding

This work was supported by the National Cancer Center Research and Development Fund [25-B-5]. This study was partially supported by the Mitsubishi Foundation, the Japan Hospice Palliative Care Foundation, and Japan Society for the Promotion of Science KAKENHI Grant Number JP16K15418.

Author information

Authors and Affiliations

  1. Palliative Care Team, Seirei Mikatahara General Hospital, 3453 Mikataharacho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan

    Masanori Mori

  2. Department of Breast Medical Oncology, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku, Tokyo, 162-8655, Japan

    Chikako Shimizu

  3. Division of Psycho-Oncology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, 6-5-1, Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan

    Asao Ogawa

  4. Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan

    Takuji Okusaka

  5. Graduate School of Education, Tohoku University, 27-1, Kawauchi, Aoba-ku, Sendai, Miyagi, 980-8576, Japan

    Saran Yoshida

  6. Palliative and Supportive Care Division, Seirei Mikatahara General Hospital, 3453 Mikataharacho, Kita-ku, Hamamatsu, Shizuoka, 433-8558, Japan

    Tatsuya Morita

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  1. Masanori Mori
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Correspondence to Chikako Shimizu.

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The funding bodies were not involved in the conducting of this study or its submission. We have no financial or personal relationships with individuals, organizations, or companies that might be perceived as a bias to this work.

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Mori, M., Shimizu, C., Ogawa, A. et al. What determines the timing of discussions on forgoing anticancer treatment? A national survey of medical oncologists. Support Care Cancer 27, 1375–1382 (2019). https://doi.org/10.1007/s00520-018-4423-7

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