Prioritizing quality of life: Study unveils advanced cancer patients' preference over survival extensionsDecember 30, 2023
Original Study: "A Longitudinal Evaluation of the Preferences of Patients With Advanced Cancer for Quality of Life and Survival in Malaysia: A Discrete Choice Experiment" by Alene Sze Jing Yong, BPharm, Ka Keat Lim, PhD, Julia Fox-Rushby, PhD, Fuad Ismail, MD, Ednin Hamzah, MD, Mark Wing Loong Cheong, PhD, Siew Li Teoh, PhD
The global landscape of cancer, with an estimated 18.1 million cases in 2018 resulting in 9.6 million deaths, underscores the urgent need for effective care strategies. Advanced stage cancer diagnoses, often associated with poor prognoses, bring about immense suffering across physical, social, spiritual, and emotional dimensions. In response to this unmet need, palliative care (PC) emerges as a multidisciplinary approach to improve the quality of life (QoL) for patients facing life-threatening illnesses. Notably, the early introduction of PC has demonstrated the potential to enhance both QoL and survival, challenging the prevailing notion of aggressive end-of-life treatments. The global challenge and the balancing act The Global Atlas of PC reveals a stark reality: only 14% of hospice and PC needs are met, predominantly affecting lower- and middle-income countries (LMICs). Striking a balance between funding for QoL improvements and survival extension becomes a complex task for health agencies worldwide. The intricate dance between cost-effectiveness thresholds and life-extending treatments has financial implications, exemplified by the evolution of the UK Cancer Drugs Fund. The challenge lies not only in access to novel treatments but also in the potential displacement of funds crucial for other essential services. Understanding patient preferences Prior systematic reviews on cancer treatment preferences have, to some extent, overlooked the nuanced trade-offs between QoL and life extension. In this context, the discrete choice experiment (DCE) emerges as a valuable method to explore patient decision-making. The study by Yong et al. delves into the preferences of advanced cancer patients in Malaysia through a DCE, offering insights into how patients trade-off changes in QoL, end-of-life (EoL) care options, and life extension. Complex healthcare landscape The study, conducted in Malaysia involved participants from a dichotomous healthcare system. The research spanned two public hospitals, the National Cancer Institute and Hospital Canselor Tuanku Muhriz, from June 2021 to August 2022. The cohort included patients aged 18 and above, newly diagnosed with stage III or IV cancer within the past six months. Importantly, this study excluded relapse patients, those receiving hospice or PC, and those with communication barriers. Surveying patient preferences: A unique approach A survey questionnaire, administered at two time points 12 weeks apart, captured the preferences of the participants. The DCE, embedded within the survey, considered seven attributes crucial in cancer management, including QoL improvements, place of death, survival, and cost. The study's rigorous methodology, involving 101 respondents at baseline and 48 at follow-up, provided robust insights into the dynamic nature of patient preferences over time. Valuing life and quality: Patient insights The study uncovered several key findings. Respondents consistently prioritized QoL improvements over survival, placing higher values on physical functioning, pain control, and home death. Notably, patients deemed additional life extension less valuable than maintaining moderate levels of QoL. Furthermore, the study revealed a shift in preferences over time, emphasizing the need for ongoing discussions between patients and clinicians to accommodate evolving preferences at different stages of cancer care. Implications for palliative care in Malaysia The study's implications for palliative care in Malaysia are profound. Despite the recognized effectiveness of PC in enhancing QoL, particularly in reducing physical, psychological, and social suffering, and providing pain relief, access remains a challenge. The Quality of Death and Dying Index 2021 underscored Malaysia's struggle, ranking 62 out of 81 countries. Alarmingly, only 13% of newly diagnosed advanced cancer patients were referred to palliative or hospice care, emphasizing the urgent need to integrate PC into the healthcare system. Bridging the gap for patient-centered care As the global community grapples with the rising cancer burden, understanding and addressing patient preferences are paramount. The study by Yong et al. contributes significantly to this endeavor by unraveling the intricate dynamics of patient decision-making. The call to action is clear – bridge the gap in palliative care access, integrate patient preferences into healthcare decision-making, and forge a path toward comprehensive, patient-centered cancer care. |
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