Palliative Care and Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, Brazil.
Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, Brazil.
Cancer Control. 2023 Jan-Dec;30:10732748231176639. doi: 10.1177/10732748231176639.
Patients with advanced cancers and their oncologists are often faced with difficult treatment decisions, especially when there are borderline situations of expected benefit or increased risk of complications. In this narrative review, we will explore the decision-making process for patients with advanced cancers and provide insights on how to approach this complex task, while didactically dividing the oncologist's assessments according to a mnemonic rule of the ABCDE of therapeutic decision-making. Part A (advanced cancer) recalls that the rule is to be used specifically for advanced cancers. Parts B (potential benefits) and C (clinical conditions and risks) represents the traditional risk vs benefit scale. In Part D, we discuss ways to identify and understand patients' desires, values, preferences, and beliefs. The prognostic estimation, from Part E, may function as an "adjust" for the antineoplastic treatment decision-making. Treatment decisions need to be conducted by skilled oncologists, in a patient-centered care, aiming to promote valuable oncology with lower rates of aggressive care.
晚期癌症患者及其肿瘤医生常常面临艰难的治疗决策，尤其是在预期获益的边缘情况或并发症风险增加时。在这篇叙述性综述中，我们将探讨晚期癌症患者的决策过程，并提供如何处理这一复杂任务的见解，同时根据治疗决策的 ABCDE 记忆规则对肿瘤医生的评估进行教学式划分。A 部分（晚期癌症）提醒该规则仅适用于晚期癌症。B 部分（潜在获益）和 C 部分（临床状况和风险）代表传统的风险与获益比。在 D 部分，我们讨论了识别和理解患者愿望、价值观、偏好和信念的方法。预后评估（E 部分）可作为抗肿瘤治疗决策的“调整”。治疗决策需要由熟练的肿瘤医生在以患者为中心的护理中进行，旨在促进有价值的肿瘤学治疗，同时降低激进治疗的比例。
