Conversations On Cancer Chemotherapy Cessation In Patients With Advanced Cancer: Qualitative Findings From A Multi-Institutional Study

Purpose:As many as 20% of oncology patients receive chemotherapy in the last 14 days of their lives. This study characterized conversations between patients and cancer clinicians on chemotherapy cessation in the setting of advanced cancer.Methods:This 3-site study captured real-time, audio-recorded interviews between oncology clinicians and patients with cancer during actual clinic visits. Audio-recordings were reviewed for discussion of chemotherapy cessation and were analyzed qualitatively.Results:Among 525 recordings, 14 focused on stopping chemotherapy; 14 patients participated with 11 different clinicians. Two types of nonmutually exclusive conversation elements emerged: direct and specific elements that described an absence of effective therapeutic options and indirect elements. An example of a direct element is as follows: " horizontal ellipsis You know this is horizontal ellipsis always really tough horizontal ellipsis But I-I think that you may need more help horizontal ellipsis I think we're close to stopping chemotherapy horizontal ellipsis And hospice is really helpful to have in place horizontal ellipsis " In contrast, the second conversation element was more convoluted: " horizontal ellipsis transplant is not an option and surgery is not an option horizontal ellipsis The options horizontal ellipsis are taking a pill horizontal ellipsis It doesn't shrink the tumor horizontal ellipsis It may help you live a little longer. But I'm worried if [you] had the pill, it's still a therapy and it still has side effects. I [am] worried if I give it to you now, that you're so weak, it will make you worse." No relationship seemed apparent between conversation elements and chemotherapy cessation.Conclusions:Conversations on chemotherapy cessation are complex; multiple factors appear to drive the decision to stop.