| Ch 13 | Page 16 / 26 | |
| Psychological aspects |
Attitude during palliative phase | |
Despite constant therapeutic progress and new treatments, death remains the outcome of a large minority of cancer sufferers.
Accompanying patients towards death is a fundamental part of the oncology care team’s role. Anglo-Saxon countries have gradually created specific palliative care structures called hospices, whereas, in France, most terminally ill cancer sufferers stay in the same hospital throughout their illness. Around 75% of our terminally ill patients die in hospital.
Although the majority of our physicians (oncologists or not) are intellectually capable of describing the disease phase after which only palliative care appears to be a reasonable attitude to adopt, many patients continue to receive chemotherapy or other curative treatments only a few days before their death from lack of dialogue.
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However, such treatment is slightly beneficial to only 10% of patients. The main reasons for this ‘therapeutic obstinacy’ are the following:
Despite major improvements in patient tolerance of chemotherapy or radiotherapy, patients continue to endure often severe complications, which they bear in the hope that they will offer improved survival. However, even if we observe a 10 to 15% response for most solid tumours, they do not represent a significant increase in survival nor (as often claimed) a systematic improvement in quality of life. The true debate on the interest of such treatment concerns asymptomatic disease, but with biological or radiological evidence of improvement (cf. cancer follow-up). |
The physician should clearly determine the best attitude in the interest of his patient, and should know when to institute salvage treatment or, on the contrary, when to stop. However, occasionally, specific situations can give way to less scientifically justified treatments, in which case, the most important factor to bear in mind is that they should not harm the patient.
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