Ethics in Oncology

I looked after one of my partner’s patients who is approaching death from advanced, refractory ovarian cancer. She asked me not to talk about anything negative with her. We can’t really make any decisions without discussing negative things. Should I just remain silent about them at her request?

Oncologists would be well advised to consider their obligations to the patient, as well as other stakeholders, and be prepared to resolve potential conflicts that go beyond the focus of their clinical training.

To place responsibility for rationing chemotherapeutics on the oncologist not only increases his or her emotional burden, but it also strains the doctor-patient relationship. We should not allow oncologists to become bedside healthcare rationers simply because no one else wants to do the job.

In this article, we have chosen to focus on three ethical challenges that we believe practicing oncologists might commonly encounter with their patients. The ethical dilemmas are presented in a case-based approach in the hope of better joining the ethical theory to clinical practice.
• Rationing Healthcare: Who's Responsible?
• The Need to Individualize Advanced Cancer Care

This article addresses some of the most common major challenges in oncologist-patient communication with a nuanced approach to the concepts of autonomy, paternalism, and culture.
• Autonomy Versus Paternalism in Latin America
• The Changing Scenario in Oncologist-Patient Communication
• Dealing With Ethical Dilemmas in Oncological Communication

The number of cancer patients and survivors continues to increase rapidly amid predictions of a shortfall in physicians. In addition, newer cancer therapies have become increasingly complex and resource-intensive.
• Where Expert Opinion Meets Public Resistance
• Caring for Cancer Patients in the Future: A Perfect Storm on the Horizon?

The BHGI is working to collaborate with colleagues in LMCs to develop practical strategies to improve outcome.
• Research Training for Low and Middle Income Countries
• International Disparity in Outcomes: The Time to Close the Gap Is Now
• Why My Neighbor’s Health Is Important to Me

As a psychiatrist who has cancer, I have developed a deep understanding of how clinicians can help patients who are facing the complicated emotional aspects of dealing with a potentially life-threatening illness. When it comes to cancer, I have been through a lot and have learned a lot.

Oncologists often do not give honest prognostic and treatment-effect information to patients with advanced disease, trying not to “take away hope.” The authors, however, find that hope is maintained when patients with advanced cancer are given truthful prognostic and treatment information, even when the news is bad.

The authors review the current trends in health literacy, patient-physician communication, and the medical treatment decision process, focusing attention on the older cancer patient population.

While there is no generally accepted medical definition of "futile care," many factors may play a role in the delivery of chemotherapy to patients who are unlikely to benefit. In this review, we consider the roles of both the patient and the physician in driving the provision of "futile care" and offer practical steps the oncologist can take to avoid it.

Integrative oncology, the synthesis of gold-standard care and evidence-based complementary modalities, deals not only with the patient’s tumor, but also with her physical and emotional needs and with the relevant cultural, scientific, and policy issues. This synthesis was one of Marty Abeloff’s main professional goals.

This paper provides an overview of several prominent articles and empirical studies on supportive care and cancer-related costs faced by older cancer patients. It focuses primarily on individuals 65 years of age and over and reviews several types of cancer.

For women with a gynecologic cancer, reproductive concerns may vary not only by site of disease but also by the presentation and manifestation of the disease. Gynecologic cancer can present before childbearing has been started or completed, during pregnancy, or can even arise out of pregnancy.

There is an increased incidence of cancer in minority populations, accompanied by reduced survival. This review will address specific areas of disparity in cancer care, including prevention, diagnosis, treatment, and outcomes, and will consider steps toward resolving these issues.