Restivo Léa, Rochigneux Philippe, Bouhnik Anne-Déborah, Arciszewski Thomas, Bourmaud Aurélie, Capodano Géraldine, Ducoulombier Agnès, Mancini Julien, Duffaud Florence, Gonçalves Anthony, Apostolidis Thémis, Proux Aurélien
Aix Marseille University, LPS, Aix-en-Provence, France.
Aix Marseille University, Inserm, IRD, ISSPAM, SESSTIM, Sciences Economiques and Sociales de la Santé & Traitement de l'Information Médicale, F-13009 Marseille, France.
Oncologist. 2025 Feb 6;30(2). doi: 10.1093/oncolo/oyae317.
While the use of chemotherapy near the end of life (EOL) has been identified as a relevant criterion for assessing quality of cancer care and has been estimated as non-beneficial, a trend of aggressiveness in cancer care during the last period of life remains. Both patients' sociodemographic characteristics and physicians' practice setting are associated with this use. The role of patients' psychosocial characteristics has however been understudied. The objectives were to study oncologists' intention to recommend chemotherapy or therapeutic abstention in an EOL patient's case and to examine the factors associated with this decision.
A clinical vignette-based questionnaire survey was conducted. While the case presented to the participating oncologists of a patient with EGFR-mutated lung cancer, progressing after osimertinib, ECOG 3, with leptomeningeal disease (N = 146), was strictly equivalent in terms of medical aspects and age, 4 patients' non-medical characteristics were manipulated: gender, marital status, parenthood, and psychosocial characteristics ("nice" patients, patients "making strong demands," or control patients).
77.4% of the oncologists surveyed stated that they would recommend chemotherapy in this situation. Only scenarios with nice patients or patients making strong demands were associated with less recommendation of chemotherapy (70.8% for the nice/making strong demands scenarios together vs 87.7%, for the control scenario P = .017). Medical oncologists with previous experience of similar cases were also less keen to recommend chemotherapy (73% vs 100%, P = .007). Of the 76.7% of respondents declaring that they would think of other therapeutic options, 49.1% mentioned "other treatments" without mentioning palliative care.
Developing physicians' awareness of the psychosocial aspects at stake in their medical decisions in these sensitive situations may improve EOL care.
虽然在生命末期（EOL）使用化疗已被确定为评估癌症护理质量的一个相关标准，并且据估计并无益处，但在生命最后阶段积极治疗癌症的趋势依然存在。患者的社会人口学特征和医生的执业环境都与这种使用情况相关。然而，患者心理社会特征的作用尚未得到充分研究。目的是研究肿瘤学家在EOL患者病例中推荐化疗或放弃治疗的意愿，并检查与此决定相关的因素。
进行了一项基于临床病例 vignette 的问卷调查。向参与调查的肿瘤学家呈现了一名表皮生长因子受体（EGFR）突变的肺癌患者的病例，该患者在使用奥希替尼后病情进展，东部肿瘤协作组（ECOG）体能状态评分为3，伴有软脑膜疾病（N = 146），在医学方面和年龄上严格等同，同时对4名患者的非医学特征进行了操控：性别、婚姻状况、是否有子女以及心理社会特征（“友善”患者、“提出强烈要求”的患者或对照患者）。
77.4%的接受调查的肿瘤学家表示他们会在这种情况下推荐化疗。只有友善患者或提出强烈要求的患者的情景与较少推荐化疗相关（友善/提出强烈要求情景的总体推荐率为70.8%，而对照情景为87.7%，P = 0.017）。有类似病例既往经验的肿瘤内科医生也不太倾向于推荐化疗（73%对100%，P = 0.007）。在宣称会考虑其他治疗选择的76.7%的受访者中，49.1%提到了“其他治疗”，但未提及姑息治疗。
提高医生对这些敏感情况下其医疗决策中所涉及的心理社会方面的认识，可能会改善EOL护理。
