r/science • u/mvea Professor | Medicine • 1d ago

Cancer Study finds many doctors disregard wishes of cancer patients. Frequently, patients with advanced cancer simply want to be made as comfortable as possible as they wind down their final days. Many of these patients are receiving treatment focused on extending their lives rather than easing their pain.

https://www.upi.com/Health_News/2025/08/26/cancer-patients-treatment-wishes-study/7921756217134/
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u/mvea Professor | Medicine 1d ago

I’ve linked to the news release in the post above. In this comment, for those interested, here’s the link to the peer reviewed journal article:

https://acsjournals.onlinelibrary.wiley.com/doi/abs/10.1002/cncr.35976

From the linked article:

Study finds many doctors disregard wishes of cancer patients

Frequently, patients with advanced cancer simply want to be made as comfortable as possible as they wind down their final days.

Doctors aren't listening to their desires, a new study indicates.

Many of these patients are receiving treatment focused on extending their lives rather than easing their pain, researchers reported Monday in the journal Cancer.

In fact, they are twice as likely to say they're receiving unwanted life-extending care than patients with other critical illnesses, results show.

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u/Soliden 1d ago

Is that taking into account palliative chemo? Couldn't treating the cancer be effective too, such as keeping the tumors small for example, be effective at managing pain and making the patient more comfortable?

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u/ineed_that 1d ago

You might be thinking of palliative radiation which is more focused on a small area. Usually cancer pain is treated with opioids and other meds 

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u/sallysfeet 1d ago

No, palliative chemotherapy is a very real thing

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u/ineed_that 1d ago

I know it’s a thing but most of these patients I’ve had that have gotten it don’t have much pain relief with it. Usually they have better luck with radiation 

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u/dishabituation 1d ago

No, sorry, it really depends on type of cancer. I’m receiving palliative chemo now.

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u/vavavoo 1d ago

No, patients can be on palliative chemo for years. The indication is not only pain. Keeping the tumor as small as possible recides all kinds of negative tumor related effects.

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u/lilbelleandsebastian 1d ago

the indication for palliative chemo is almost never pain - good luck shrinking tumors or erasing bony micromets with a substandard chemo regimen in an unstudied patient population - but it's rarely effective, either, outside of fairly indolent cancers that may not have needed any palliative treatment at all. we whole brain radiate small cell on diagnosis despite knowing that they're going to die quickly regardless.

impossible to get an oncologist to offer anything but treatment to their own patients so important to be frank about that in a thread like this with 99% laypeople. of course i'm biased because i'm the one that has to take care of these patients and explain to their families that the oncologist was not being truthful when they omitted all the important contexts around cancer treatment

there's somewhere in between many european countries (where the physician just tells you care is futile, begin the grieving process) and the US (where the oncologist is enrolling your corpse in a clinical trial on the way to the crematorium) but i don't think we'll ever find it

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u/Mitten5 MD | Neurosurgery 1d ago

I agree with all of your points but I did want to chime in when you say it's "impossible to get an oncologist to offer anything but treatment." The way I have put our system in perspective (I'm a neurosurgeon fwiw) is that the oncologist's role is more or less to offer what options could be available, and what the outcomes could be. It's my role as a specialist to parse those and say which of those ideas are good and bad. I mostly treat oncologists as playing "good cop" all of the time. I also feel like it's bit of a conflict of interest for oncologists to tell patients "no more treatment," which could be construed as withholding care. It's my job to say "ok you're on year 3 with lung cancer, you're on 2nd line therapy, you're emaciated, you're exhausted, and now this treatment is failing too because you have new brain and liver mets? Maybe talking about brain tumor surgery is missing the forest for a tree."

In an ideal world, patients would have insight as to how they feel and how their bodies are doing. In an ideal world, the families would be listening to their loved one to know what their priorities are and if things are going the wrong direction. In an ideal world, the patient and family would be in charge of the conversation with the oncologist offering further treatment in order to say enough, let's transition to palliation. In reality average people have little to no insight or feeling for their own bodies and minds, and a hefty amount of exceptionalism. A touch more paternalism may be helpful to make patients feel comfortable with making a "negative choice," so if I have to be the "bad cop" then that's a role I'm comfortable playing (neurosurgeons are perceived to be jerks anyways).

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u/FrenchHornMD 1d ago

As far as I can see in this abstract it is based on patient reports. So it is quite subjective if that is true though the manner how these reports are collected isnt clear to me. Is this a US-only study? Can't see where this data was collected. In my experience we are quite liberal with euthanasia and palliative sedation. The family is mostly the biggest slowing factor in organizing appropiate care. This being said, our experience in primary care is that it is mostly the tertiary centres which keep focussing in lifeproloning treatments. Often downplaying the severity and frankly being dishonest. But this only my experience as a European GP.

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u/HerculesIsMyDad 1d ago

This is certainly a factor, families can pressure patients into doing treatments they otherwise wouldn't want. Some patients will also just go along with whatever the doctor says and not express their wishes openly. We should of course take every opportunity to remind providers to respect patient's wishes, but I feel headlines like this will just be picked up on people who have a bone to pick with doctors, or just one particular doctor, and use it as proof that doctors all suck and their favorite "wellness" influencer has all the real answers.

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u/FrenchHornMD 22h ago

Communication from both sides is key concerning this topic. Some patients will certainly use this to justify their opinion of doctors. However there are certainly doctors who ignore the patients wishes altogether, believing themselves omnicient. This I can tell through personal experience with certain colleagues.

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u/sadi89 1d ago

I think a big part of the problem is that a lot of doctors are uncomfortable bringing up the topic of death and along with that hospice and even palliative care. Patients can also be uncertain of what their options are and feel weird about challenging a doctors plan because in this situation the doctor is an authority figure. As a result the patient may under express their actual wishes. Sometimes patients don’t actually fully understand the plan of care the doctor has outlined for them and neither the patient or the doctor realize that there has been a miscommunication. Many times this is because for the doctor this treatment and conversation are routine, they explain it 5 times a day, and due to their own familiarity with it forget to include important details. It happens to people in any profession. Patients on the other hand can be overwhelmed, anxious, or not able to fully focus on what’s being said due to pain or disease process. Patients can miss important details in their treatment plans that would actually be make or break for their decision to move forward with treatment.

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u/FrenchHornMD 22h ago

You've really hit the nail on the head with some of your remarks. If often find myself having to explain to patients what the specialist have told them. They are always in a hurry, explain their plan and don't leave a lot of room for questions. I'm a big believer in early planning. If possible I try to have the discussion about end-of-life treatment/wishes early. Oftentimes when my elderly patients are still healthy. This way I can try to fullfill their wishes if they are unable to. In my opinion the GP is best placed to fullfill this role. I don't find this awkward but it isn't a conversation you can strike up with every patient. It's difficult to keep being mindfull of the patients point of view. Somethings which are selfexplanatory as a professional arent that way for a patient. I talk to my patients in the local dialect and try to portray myself as human. This way I hope to get rid of this view as an authority figure and help them to voice their concerns. This is my way of thinking/working, not all doctors work like this nor do I claim this to be the best way. It's the way that suits me best.

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u/lettsten 1d ago

I assume France? My impression and experience from here in Norway is very much in line with these findings

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u/FrenchHornMD 22h ago

Belgium actually :) Weird, my perception of Norwegian, and Nordic health Care in general, is that it is superior to ours. More humane and more performant. But that's not with any personal experience of the workings there.

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u/meowingtrashcan 1d ago

OP, do you think the methodology of this paper actually supports this article title and argument?

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u/EusebioFOREVER 1d ago

The cancer itself causes pain. If you can kill enough cancer cells you can not only extend life but also provide pain relief.

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u/Sushi_Explosions 23h ago

The study does not indicate that at all, your title is a terrible and slanderous editorialization.

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u/GodeaterTheHalFeral 1d ago

This should be a crime.

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u/Belyea 1d ago

This is especially disturbing after reading an article just yesterday about how most doctors with terminal diagnoses prefer palliative care over life-extending care.

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u/King-of-Plebss 1d ago

Hmm I wonder how much more money the hospital and insurance companies can bill and then take out of the estate when they keep them alive and spend as much money as possible in their final days.

This sure is a mystery, Scoob!

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u/Briantastically 1d ago

Oncologists are, as far as I’m aware, the only doctors also allowed to act as pharmacist. So you get the chemo, anti-nausea meds etc from them and they are the ones that profit. If you were to get the drugs to self administer the cost difference is astounding.

The profit motive is strong for treatment for oncologists.

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u/Party-Tonight8912 1d ago edited 1d ago

Do you not consider anti-nausea meds necassary and comfort focused? Also theyr're pretty cheap.

But to the resto f you're point:

There is concern that doctors are prescribing the most profit specific option for treatment with equivalent therapeutic and adverse affect. This can generally be an issue specific to oncology, as unlike many fields there are regularly novel drugs that rely on physician discretion as data is initially limited.

It's actively being studied, but the direct dispensing model hasn't been shown to have significantly changed the amount of medication dispensed. At most there has been a change from IV drugs administered at an infusion clinic to more oral drugs.

There is certainly no indication that physicians are pushing terminal patients towards life extending care just for profit.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2819040

https://ldi.upenn.edu/our-work/research-updates/rapid-growth-in-oncology-practices-directly-dispensing-cancer-drugs/

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u/Briantastically 23h ago

This is a very useful counterpoint thank you.

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u/Sushi_Explosions 23h ago

None of those things are even remotely true.

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u/reincarnateme 1d ago

Patients are Guinea pigs