Chemotherapy for advanced breast cancer: what influences oncologists' decision making?

Chemotherapy is widely used in the management of patients with advanced bre ast cancer. However, a considerable proportion of patients experience toxic side effects without gaining benefit. This study aimed to elicit oncologis ts' views of the goals of chemotherapy for patients with advanced breast ca ncer and to elicit which factors are important in decisions to recommend ch emotherapy to such patients. 30 oncologists underwent a semi-structured int erview to examine their views of 5 goals of chemotherapy and of various dis ease, treatment and patient-related factors that might influence decisions to offer treatment. The clinicians also made decisions regarding treatment in relation to a hypothetical patient scenario under varying clinical condi tions. Relief of symptoms and improvement of activity were rated as the mos t valuable and achievable goals of treatment. The patient's performance sta tus, frailty and their wishes regarding treatment were the most important p atient-related factors in determining decision-making. The most important d isease/treatment-related factors were pace of the disease, previous poor re sponse to chemotherapy co-existing symptoms and concurrent medical conditio ns. The hypothetical scenario revealed that cc-existing medical conditions, adverse previous response, increased age and depression would decrease the likelihood of recommending chemotherapy, whereas key symptoms (e.g. breath lessness) and the patient's goals would increase the likelihood. The findin gs suggest that British oncologists primarily aim to improve patients' phys ical function, although subjective factors, such as a patient's desire for anti-cancer treatment and their future goals, also influence decisions to o ffer treatment. (C) 2001 Cancer Research Campaign.