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Care at the Close of Life: Evidence and Experience
Stephen J. McPhee, Margaret A. Winker, Michael W. Rabow, Steven Z. Pantilat, Amy J. Markowitz
Part D Other Patient Management Issues
Chapter 22. The Role of Chemotherapy at the End of Life: “When Is Enough, Enough?”
Sarah E. Harrington, MD, Thomas J. Smith, MD
Table 22-1 Palliative Chemotherapy for Metastatic Disease for Four Common Solid Tumors


Topics Discussed: breast cancer, cancer, advanced, chemotherapy regimen, clinical decision making, palliative care, physician-patient relations

Excerpt: "Patients may find it hard to get or accept truthful information about the benefits and harms of palliative chemotherapy. In the largest study of 95 consecutive patients receiving palliative chemotherapy, prognosis was discussed by only 39% of medical oncologists.4 In a longitudinal study of hospitalized patients for whom death was believed imminent, families reported that the attending physician never discussed the possibility of death 62% of the time and no one on the medical team discussed the possibility of death with cancer patients in 39% of cases.5 In other studies, at least one-third of patients and families reported they did not believe the information given them that treatment was not curative despite receiving such information.6,7 Another study showed that physicians may "collude" in this hopefulness by giving such a wide range of outcomes that people choose the most favorable.8..."
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