A STOPPING RULE FOR STANDARD CHEMOTHERAPY FOR METASTATIC BREAST-CANCER - LESSONS FROM A SURVEY OF MARYLAND MEDICAL ONCOLOGISTS

The sequential administration of standard chemotherapy regimens to tre at metastatic breast cancer may keep patients and oncologists from con sidering other important, but more psychologically difficult, issues s uch as the patient's declining health or approaching death. This pract ice also utilizes health care resources for ever-decreasing individual patient benefit. If generally agreed-upon rules or guidelines were de veloped about slopping standard chemotherapy after a limited number of regimens, oncologists could recommend treatment discontinuation with greater confidence. Also, resources could be redirected. To inform the development of guidelines on when to stop chemotherapy for metastatic breast cancer, we surveyed fully trained Maryland medical oncologists about their knowledge and beliefs about chemotherapy for metastatic b reast cancer. The survey instrument included open-ended questions and clinical vignettes. There was consensus about the value of first-line chemotherapy. Even though oncologists employed second-line chemotherap y, they were unenthusiastic about it. The frequent utilization of seco nd-line regimens probably reflects an effort to offer marginal regimen s to patients who want them. Based on these data, it is suggested that standard chemotherapy be stopped after breast cancer fails to stabili ze or respond on a standard regimen. Patients who wish further treatme nt could be referred for investigational therapy if it is available an d if they are eligible.