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Palliative intent systemic anticancer therapy (SACT) is a key component of treatment in advanced lung cancer. Indications for the commencement of a given regimen are typically well-defined in evidence-based guidelines. For patients who undergo palliative intent SACT, there is typically a point where the risk–benefit assessment does not favour continuing therapy due to demonstrable lack of efficacy or intolerable toxicity. In these situations, a discussion may occur between the clinician and patient regarding cessation of SACT, potentially resulting in the adoption of a purely palliative approach to symptom management. These discussions and decisions are a part of everyday practice for medical oncologists, who have a professional responsibility to offer timely patient-centred interventions with consideration for patient and family preferences, including discontinuation of some treatments when appropriate.1 Appropriately timed cessation of treatment is a recognised cancer treatment quality indicator,2 yet best practice is currently largely undefined, with no recognised evidence-based guidelines to indicate when treatment should be ceased.
We sought to explore the timing and nature of treatment cessation decisions and discussions with patients at our institution by retrospectively reviewing clinical documentation. We reviewed all referrals for advanced lung cancer (stage 4 and stage 3 disease where definitive intent concurrent chemoradiotherapy was not administered) received at Lyell McEwin Hospital in Adelaide, Australia (‘the institution’) …
Contributors KJO and CMH conceptualised the project. KJO collected data. MOF performed analyses and constructed the manuscript. KJO and CMH contributed to manuscript development.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; internally peer reviewed.