To Treat or Not to Treat? Dilemmas when Deciding on Antineoplastic Treatment in Patients With Far Advanced Cancers

Sep 24, 2026

Uploaded by Levi

Patients with advanced cancers and their oncologists face difficult treatment choices, particularly when expected benefit is borderline or when complication risk rises. This narrative review analyzes decision-making for advanced cancer care and explains a structured ABCDE mnemonic. Part A applies to advanced cancer; Parts B and C weigh potential benefits against clinical risks. Part D addresses patient values and preferences, while Part E guides prognostic estimation to “adjust” decisions. Treatment should be delivered by skilled oncologists using patient-centered care to pursue meaningful oncology with less aggressive treatment.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Abstract

Introduction

Personalized oncology and emerging therapies

Treatment cessation dilemmas and communication challenges

End-of-life chemotherapy harms and quality indicators

Early integration of palliative care benefits

Keywords

To Treat or Not to Treat? Dilemmas when Deciding on Antineoplastic Treatment in Patients With Far Advanced Cancers Cancer Control Volume 30: 1–16 © The Author(s) 2023 Article reuse guidelines: [sagepub.com/journals-permissions](sagepub.com/journals-permissions) [DOI: 10.1177/10732748231176639](DOI: 10.1177/10732748231176639)[ ](DOI: 10.1177/10732748231176639)[journals.sagepub.com/home/ccx](journals.sagepub.com/home/ccx) Carlos Eduardo Paiva, MD, PhD 1,2 􀀁, Daniel D’Almeida Preto, MD, PhD 1,2, Crislaine de Lima, MSc 1, and Bianca Sakamoto Ribeiro Paiva, PhD 1 Abstract Patients with advanced cancers and their oncologists are often faced with difﬁcult treatment decisions, especially when there are borderline situations of expected beneﬁt or increased risk of complications. In this narrative review, we will explore the decision-making process for patients with advanced cancers and provide insights on how to approach this complex task, while didactically dividing the oncologist’s assessments according to a mnemonic rule of the ABCDE of therapeutic decision-making. Part A (advanced cancer) recalls that the rule is to be used speciﬁcally for advanced cancers. Parts B (potential beneﬁts) and C (clinical conditions and risks) represents the traditional risk vs beneﬁt scale. In Part D, we discuss ways to identify and understand patients’ desires, values, preferences, and beliefs. The prognostic estimation, from Part E, may function as an “adjust”for the antineoplastic treatment decision-making. Treatment decisions need to be conducted by skilled oncologists, in a patientcentered care, aiming to promote valuable oncology with lower rates of aggressive care. Keywords neoplasms, palliative care, decision-making, toxicity, cancer therapy, prognosis, advance care planning Received March 27, 2023. Received revised April 16, 2023. Accepted for publication April 28, 2023. Introduction Clinical oncology has come a long way in recent decades, moving from a phase focused on cytotoxic antineoplastics to the era of personalized medicine, which includes numerous new molecularly targeted drugs, such as a focus on several driver mutations and signaling pathways (such as BRAF, HER2, ALK, PI3K, PTEN, FGF) .1 Other examples are the effective use of ADP ribose polymerase inhibitors (PARPi) for the treatment of ovarian and breast BRCA-mutated cancers2 and the new antibody-drug conjugate drugs,3 such as Trastuzumab Entamsine, Sacituzumab Govitecan, and Trastuzumab deruxtecan, for the treatment of breast cancer. In addition, the use of immune checkpoint inhibitors is revolutionizing the treatment of several types of malignant neoplasms and keeps moving forward.4 Despite enormous therapeutic advances, most treatments are still offered to prolong and facilitate patient survival, hence called palliative antineoplastic treatment. In this context of multiple systemic therapeutic options, the oncologist, who has an optimistic nature and often personal difﬁculty in dealing with situations of ﬁnitude, ﬁnds himself in the difﬁcult situation of suspending an antineoplastic treatment. The “availability bias,”5 a mental shortcut that relies on immediate examples that come to mind, for example with the 1 Palliative Care and Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, Brazil 2Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, Brazil Corresponding Author: Carlos Eduardo Paiva, MD, PhD, Departamento de Oncologia Cl´ınica, Rua Antenor Duarte Vilela, 1331, Barretos CEP 14784-400, Brazil. Email: [caredupai@gmail.com](caredupai@gmail.com) Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)) which permits non-commercial use, reproduction and distribution of the work without further permission

FAQs

What challenges arise when deciding antineoplastic treatment for far advanced cancers?

Decisions become difficult when the expected benefit is borderline and the risk of complications is increased, especially near the end of life.

How does the article’s ABCDE mnemonic structure therapeutic decision-making?

Part A focuses on advanced cancer, Parts B and C address potential benefits and risk versus benefit, Part D explores patient desires and values, and Part E uses prognostic estimation to adjust treatment decisions.

Why can chemotherapy in the last days of life be harmful?

It may decrease quality of life, raise costs, and does not improve survival, and end-of-life use is linked to overly aggressive care when integrated palliative philosophy is lacking.

Sep 24, 2026

Uploaded by Levi