3 contemplations about cancer advice


Cancer treatment recommendations teeter on a number of physician factors — most notably the depth of the doctor-patient relationship and the consulting physician’s vantage of a patient’s life situation and age — according to researchers from Ruhr-Universität Bochum and the University of Oxford.

Research groups were assembled in various areas to gauge how patients perceived and evaluated the information given to them by their doctors regarding difficult diagnoses, like cancer. All results culminated in a medical ethicist report.

"Treatment decisions in advanced, life-threatening diseases are among the most difficult challenges in medicine,"said Jan Schildmann, head of the North Rhine-Westphalian junior research group ["Medical Ethics at the End of Life: Norm and Empiricism"] and lead author of the study, in a prepared statement.

The main findings of the report were benchmarked and relayed by Schildmann and the research team as follows:

Personal values influence treatment recommendations of doctors
When making decisions for or against a therapy, in addition to medical factors, the age and life situation of patients played a role — for example, whether they had a family. Thus, one of the doctors participating in the interview study said: "I think instinctively you feel that this is a young patient with a young family you need to make even more effort to try and help them live for a bit longer." The doctors also made comparisons to their own age and their own life situation. "I most recently had a young woman...with teenage daughters, the same age as my daughters, so there was a kind of sense of...it shouldn't influence, but you can picture the person the same as yourself," as an example from one of the interviews. The results of the studies carried out in England are consistent with previously published results from Germany.

The wishes of the patients change over the course of the disease
"I placed my life and my illness in the hands of the specialists and said you will do this right," one of the participants explained. In the course of the disease, however, the people learned to process the doctors' words better; then they wanted more information and to be involved in the decision on possible therapies.

Value judgements
"The results of this qualitative study cannot be applied to the entire cohort of oncologists, or all patients with cancer," said Schildmann. However: "Doctors should reflect on the value judgments that play a role in the recommendations. They should also consider what information really enables patients to participate in decision-making according to their wishes at a certain time."

The report was published in the latest editions of the journals The Oncologits and the Annals of Oncology.