Approaching a Terminally Ill Patient's Request to Stop Chemotherapy
Understanding the Transition in Treatment Goals
- For patients with months to weeks to live, the focus of treatment should shift from prolonging life toward maintaining quality of life, as recommended by the National Comprehensive Cancer Network 1, 2
- Patients at this stage are typically tired of therapy, homebound, and concerned about treatment side effects, according to the National Comprehensive Cancer Network guidelines 2, 3
Recommended Approach to the Conversation
- The American College of Physicians and other medical societies acknowledge that 90% of patients want to know their options and be involved in treatment decisions, including the option of discontinuing treatment 2, 4
- Patients have the right to make informed decisions about their care, including stopping chemotherapy, as supported by the National Comprehensive Cancer Network 1
Providing Clear Information and Reframing the Conversation
- The National Comprehensive Cancer Network recommends discussing the anticipated disease course and prognosis honestly with patients 5, 6
- Confirming the patient's understanding of treatment goals and preferences regarding prognostic information is crucial, as emphasized by the National Comprehensive Cancer Network 2
- Explaining that patients with weeks to days to live should not be given anticancer therapy but should receive intensive palliative care focusing on symptom management is in line with the National Comprehensive Cancer Network guidelines 1, 3
- Reframing the discontinuation of chemotherapy as "fighting for better quality of life" instead of "giving up" is a recommended approach by the National Comprehensive Cancer Network 1, 2
Discussing Palliative Care Options
- Offering best supportive care, including referral to palliative care or hospice, is a key component of comprehensive care, as recommended by the National Comprehensive Cancer Network 5, 3
- Explaining that palliative care focuses on symptom control and preparation for the anticipated disease progression is essential, according to the National Comprehensive Cancer Network 1, 8
- Addressing specific symptoms like pain, dyspnea, fatigue, and psychological distress that can be managed effectively without chemotherapy is critical, as emphasized by the National Comprehensive Cancer Network 3, 6