How does parental status influence preferences for cancer treatment and palliative care?

65 Background: When patients with metastatic cancer have dependent children, they may be less likely to acknowledge the terminal nature of their illness and more willing to accept toxic treatments for small improvements in survival, compared to patients without children. Our mixed methods study sought to clarify the role of parental concerns in treatment decision-making. Methods: We recruited 63 patients with metastatic cancer who have children <18 to complete measures of physical and social wellbeing. 47 (75%) also participated in a semi-structured interview, which included questions about whether parental status influences patients’ decisions about anti-cancer treatment and whether patients would consider using palliative care, including hospice. We used univariable logistic regression to examine the relationship between patient and family characteristics and 3 outcomes: 1) influence of parental status on treatment decision-making, 2) interest in palliative care, and 3) interest in hospice. We used participants’ qualitative comments to describe the context for their preferences. Results: Average patient age was 44; average number of children was 2, and average child age was 13. 70% of patients reported that being a parent influences their treatment decisions. 64% cited parental status as motivation for life-extending treatment. 15% prioritized preserving parental functioning. Half of patients said they would consider using palliative care, and 57% said they would consider using hospice. Reasons for disinterest in palliative care and hospice included concerns about being perceived as giving up and children’s exposure to death at home. Parents with older children (OR 0.85, p=0.03), and those with increased social support (OR 0.96, p=0.05) had lower odds of reporting an influence of parental status on treatment decisions. Children’s age (OR 0.85, p=0.02) and low performance status (OR 4.3, p=0.02) were associated with palliative care interest. Conclusions: Parental concerns may influence treatment decision-making for metastatic cancer patients with children. Information about parental concerns may help oncologists to align treatment with patients’ priorities.

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Parental Status in Treatment Decision Making among Women with Nonmetastatic Breast Cancer

Medical Decision Making ◽

10.1177/0272989x20918606 ◽

2020 ◽

Vol 40 (4) ◽

pp. 540-544

Author(s):

Patricia I. Jewett ◽

Rachel I. Vogel ◽

Mary C. Schroeder ◽

Joan M. Neuner ◽

Anne H. Blaes

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Cancer Treatment ◽

Treatment Decision ◽

The United States ◽

Treatment Decisions ◽

Bilateral Mastectomy ◽

Parental Status ◽

Dependent Children ◽

Treatment Decision Making

Background. Having dependent children may affect cancer treatment decisions. We sought to describe women’s surgery and chemotherapy decisions in nonmetastatic breast cancer by parental status. Methods. We conducted a secondary analysis of the 2015 cross-sectional Share Thoughts on Breast Cancer Study, conducted in 7 Midwestern states in the United States, restricted to women of prime parenting age (aged 20–50 years) who consented to the use of their medical records ( N = 225). We examined treatment decisions using data visualization and logistic regression (adjusted for age, stage, family history of breast cancer, income, education, race, health insurance, and partner status). Results. Women with dependent children received bilateral mastectomy more often than women without dependent children (adjusted odds ratio 3.09, 95% confidence interval 1.44–6.62).We found no differences in the receipt of chemotherapy by parental status. Women reported more active roles in surgery than in chemotherapy decision making. Conclusions. As a likely factor in cancer treatment decisions, parental status should be addressed in clinical practice and research. Future research should assess patients’ sense of ownership in treatment decision making by treatment type.

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HSR19-089: Misperceptions Regarding Palliative and Hospice Care Among Cancer Patients: What Can We Learn from Patient-Reported Treatment Decision Making

Journal of the National Comprehensive Cancer Network ◽

10.6004/jnccn.2018.7230 ◽

2019 ◽

Vol 17 (3.5) ◽

pp. HSR19-089

Author(s):

Sara Hayes ◽

Brian M. Green ◽

Shayna Yeates ◽

Amrita Bhowmick ◽

Kaitlyn McNamara ◽

...

Keyword(s):

Quality Of Life ◽

Decision Making ◽

Palliative Care ◽

Cancer Care ◽

Hospice Care ◽

Treatment Decision ◽

Treatment Decisions ◽

Treatment Decision Making ◽

Diagnosis Of Cancer

Background: Despite NCCN Guidelines and clear definition of palliative care, patients often carry misperceptions about palliative care and how it can be beneficially integrated into a patient’s care plan. In order to better understand the misinformation about palliative and hospice care, this study aims to assess patient-healthcare provider (HCP) communication regarding treatment decisions. Methods: An online survey was conducted with individuals who have had a diagnosis of cancer (n=1,517) to better understand their healthcare experiences as well as the impact their cancer diagnosis had on their quality of life. Measures included agreement scale questions assessing patient information needs surrounding treatment decision making. Open-ended questions where respondents were prompted to provide a written response allowed researchers to further assess patients’ understanding of palliative and hospice care. Responses to agreement-scale questions were evaluated using descriptive statistics. Openended question responses were analyzed using Dedoose qualitative data analysis software. Results: Among patients with a diagnosis of cancer, there were a broad range of patient misperceptions regarding palliative care, hospice care, and how they are used in cancer care. The majority of respondents (81%) stated that their HCP played a role when deciding on their treatment plan. Despite this, only 46% were confident they knew about the treatment’s impact on their daily life, 56% were confident they knew about the potential side effects of treatment, and 57% felt they had all of the information they needed. Themes identified through qualitative analysis include: patient conflation of palliative and hospice care, belief that palliative and hospice care are only relevant to end-of-life decision-making, and uncertainty about whether quality of life can actually be improved. Conclusions: Institutions and HCPs are recommended to integrate palliative care into cancer care. However, as this research shows, oncology patients are often misinformed about the benefits of palliative care. This follows a parallel concern of patients making treatment decisions without optimal information. A potential factor behind this unmet need may be lack of effective communication between patient and HCP. Palliative care may be mentioned by the HCP, but not discussed with enough empathy or depth, leading to patient misunderstanding and lack of inclusion in treatment plans.

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Multidimensional integrative medicine applied to outpatient cancer treatment in southern Brazil: Preliminary cost-effectiveness analysis.

Journal of Global Oncology ◽

10.1200/jgo.2019.5.suppl.5 ◽

2019 ◽

Vol 5 (suppl) ◽

pp. 5-5

Author(s):

James Freitas Fleck ◽

Ricardo Preger ◽

Luis Fernando Venegas ◽

Henrique de Araujo Vianna Trasel

Keyword(s):

Decision Making ◽

Cancer Treatment ◽

Cancer Patients ◽

Integrative Medicine ◽

Metastatic Cancer ◽

Clinical Stage ◽

Treatment Decision ◽

Cost Effective ◽

Treatment Decision Making ◽

Care Plans

5 Background: Cost-effective analysis as part of cancer treatment decision-making. Methods: We reviewed deaths of 52 metastatic cancer patients treated with multidimensional integrative medicine (MIM) approach. Patients received standard oncologic treatment plus a MIM predefined program of emotional, cognitive and social support. The method included empathy improvement, changes on physician attitude and office environment, modulation of staff behavior supporting patient’s needs and rights, promotion of belongingness, increasing on patient’s protagonism using multimedia interactive narrative and shared decision-making. Patients were categorised according to the tumor site, pathologic, molecular and IHC characteristics, clinical stage and treatment. Observed survival was defined as the time elapsed between the detection of first metastasis and death. The observed survival for each patient was compared with the median expected survival previously reported on prospective randomised trials which had accrued patients with similar prognostic factors based on a best fit model. Treatment monthly cost for each patient was converted in American dollars (USD) on a daily exchange basis. Cost of the treatment periods were compared with those analysed in four large USA commercial managed care plans. Results: Treatment of metastatic cancer patients using MIM showed a 44% increase in median survival and a 48% decrease in cost. The estimated ICER/QALY was of 32304 USD, which represented 2.0 of Brazilian PPP. Conclusions: Despite methodological limitations, this is the first study to indicate a cost-effective survival increase in metastatic cancer patients using a MIM-behavioral modulation model. [Table: see text]

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Variation in reported experience of involvement in cancer treatment decision making: evidence from the National Cancer Patient Experience Survey

British Journal of Cancer ◽

10.1038/bjc.2013.316 ◽

2013 ◽

Vol 109 (3) ◽

pp. 780-787 ◽

Cited By ~ 30

Author(s):

A El Turabi ◽

G A Abel ◽

M Roland ◽

G Lyratzopoulos

Keyword(s):

Decision Making ◽

Cancer Patient ◽

Cancer Treatment ◽

Patient Experience ◽

Treatment Decision ◽

Treatment Decision Making ◽

Experience Survey

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The Significance of Patient-Reported Outcomes for Metastatic Breast Cancer Patients

Oncology Research and Treatment ◽

10.1159/000521826 ◽

2022 ◽

Author(s):

Larissa Elisabeth Hillebrand ◽

Ulrike Söling ◽

Norbert Marschner

Keyword(s):

Breast Cancer ◽

Decision Making ◽

Metastatic Breast Cancer ◽

Cancer Treatment ◽

Patient Reported Outcomes ◽

Metastatic Breast ◽

Treatment Decision ◽

Breast Cancer Patients ◽

Treatment Decision Making ◽

Patient Reported

Background: Breast cancer is still the most common malignancy in women worldwide. Once metastasized, breast cancer treatment primarily aims at reducing symptom burden, thereby trying to maintain and improve a patient´s quality of life (QoL), delaying disease progression, and prolonging survival. Curing the disease is not possible in the palliative setting. To better understand metastatic breast cancer patients, their symptoms and wishes, which are important for treatment-decision making and outcome, patient-reported outcomes (PROs) are of great importance, giving an impression of what really matters to and concerns a patient. Summary: Many advances have been made to implicate PROs in clinical trials, non-interventional studies, registries, and clinical routine care of metastatic breast cancer. For example, large phase III trials like PALOMA-3 (NCT01942135), MONALEESA-7 (NCT02278120), HER2CLIMB (NCT02614794), and KEYNOTE-119 (NCT02555657) trials implemented PROs in their trial design to assess the QoL of their trial patients. Also, non-interventional studies on metastatic breast cancer, like e.g., the NABUCCO study (IOM-02240), and prospective non-interventional, multicenter registries e.g., the tumor registry breast cancer (NCT01351584) or the breast cancer registry platform OPAL (NCT03417115), have implemented PROs to assess QoL during the anti-cancer treatment periods of the patients. Key Message: Using PROs in metastatic breast cancer can support shared treatment-decision making and management of symptoms, eventually leading to an improvement in QoL. Progressively, regulatory authorities take PROs into consideration for the approval of new drugs. Hence, the implication of PROs in cancer treatment, and especially in MBC, is of significant value.

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