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Dilemmas when Deciding on Antineoplastic Treatment in Patients With Far Advanced Cancers","","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.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/to-treat-or-not-to-treat-dilemmas-when-deciding-on-antineoplastic-treatment-in-patients-with-far-advanced-cancers/378867/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/to-treat-or-not-to-treat-dilemmas-when-deciding-on-antineoplastic-treatment-in-patients-with-far-advanced-cancers/378867.png","ImageObject",300,407,{"name":92,"@type":93},"Levi","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-02","2026-09-24",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What challenges arise when deciding antineoplastic treatment for far advanced cancers?","Question",{"text":112,"@type":113},"Decisions become difficult when the expected benefit is borderline and the risk of complications is increased, especially near the end of life.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How does the article’s ABCDE mnemonic structure therapeutic decision-making?",{"text":117,"@type":113},"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.",{"name":119,"@type":110,"acceptedAnswer":120},"Why can chemotherapy in the last days of life be harmful?",{"text":121,"@type":113},"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.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},378867,1790536862,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":36},7971461740909,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","To Treat or Not to Treat? Dilemmas when Deciding on Antineoplastic Treatment in Patients With Far Advanced Cancers  \nCancer Control Volume 30: 1–16  \n© The Author(s) 2023  \nArticle reuse guidelines:  \n[sagepub.com/journals-permissions](sagepub.com/journals-permissions)  \n[DOI: 10.1177/10732748231176639](DOI: 10.1177/10732748231176639)[ ](DOI: 10.1177/10732748231176639)[journals.sagepub.com/home/ccx](journals.sagepub.com/home/ccx)  \nCarlos 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  \nAbstract  \nPatients 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.  \nKeywords  \nneoplasms, palliative care, decision-making, toxicity, cancer therapy, prognosis, advance care planning  \nReceived March 27, 2023. Received revised April 16, 2023. Accepted for publication April 28, 2023.  \nIntroduction  \nClinical 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  \npatient survival, hence called palliative antineoplastic treatment.  \nIn 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  \n1 Palliative Care and Quality of Life Research Group (GPQual), Barretos Cancer Hospital, Barretos, Brazil  \n2Department of Clinical Oncology, Barretos Cancer Hospital, Barretos, Brazil  \nCorresponding Author:  \nCarlos Eduardo Paiva, MD, PhD, Departamento de Oncologia Cl´ınica, Rua Antenor Duarte Vilela, 1331, Barretos CEP 14784-400, Brazil.  \nEmail: [caredupai@gmail.com](caredupai@gmail.com)  \nCreative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons  \nAttribution-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,  \nreproduction and distribution of the work without further permission","cbCaisWSbQe1WJ0M","https://ap.wps.com/l/cbCaisWSbQe1WJ0M","pdf",800703,16,"English","# Abstract\n# Introduction\n## Personalized oncology and emerging therapies\n## Treatment cessation dilemmas and communication challenges\n## End-of-life chemotherapy harms and quality indicators\n## Early integration of palliative care benefits\n# Keywords","[{\"question\":\"What challenges arise when deciding antineoplastic treatment for far advanced cancers?\",\"answer\":\"Decisions become difficult when the expected benefit is borderline and the risk of complications is increased, especially near the end of life.\"},{\"question\":\"How does the article’s ABCDE mnemonic structure therapeutic decision-making?\",\"answer\":\"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.\"},{\"question\":\"Why can chemotherapy in the last days of life be harmful?\",\"answer\":\"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.\"}]","To Treat or Not to Treat? Dilemmas when Deciding on Antineoplastic Treatment in Patients With Far Advanced Cancers | PDF",1790232932]