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.

[u/mvea]

https://www.upi.com/Health_News/2025/08/26/cancer-patients-treatment-wishes-study/7921756217134/

[u/Soliden]

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?

[u/ineed_that → u/Soliden]

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 

[u/sallysfeet → u/ineed_that]

No, palliative chemotherapy is a very real thing

[u/ineed_that → u/sallysfeet]

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 

[u/dishabituation → u/ineed_that]

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

[u/vavavoo → u/ineed_that]

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.

[u/lilbelleandsebastian → u/vavavoo]

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

[u/Mitten5 → u/lilbelleandsebastian]

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).