American Society of Clinical Oncology Statement: Toward Individualized Care for Patients With Advanced Cancer

TLDR

Advanced incurable cancer patients experience complex physical, psychological, social, and spiritual challenges, and evidence shows that discussions about prognosis, treatment benefits, and palliative care are frequently delayed or omitted. This article presents ASCO’s vision for improved communication and decision‑making for advanced cancer patients. The statement promotes an individualized approach to discussing disease‑directed and supportive care options, reviews evidence for better outcomes when goals and preferences are addressed, and outlines barriers and strategies to achieve this vision.

Abstract

Patients with advanced incurable cancer face complex physical, psychological, social, and spiritual consequences of disease and its treatment. Care for these patients should include an individualized assessment of the patient's needs, goals, and preferences throughout the course of illness. Consideration of disease-directed therapy, symptom management, and attention to quality of life are important aspects of quality cancer care. However, emerging evidence suggests that, too often, realistic conversations about prognosis, the potential benefits and limitations of disease-directed therapy, and the potential role of palliative care, either in conjunction with or as an alternative to disease-directed therapy, occur late in the course of illness or not at all. This article addresses the American Society of Clinical Oncology's (ASCO's) vision for improved communication with and decision making for patients with advanced cancer. This statement advocates an individualized approach to discussing and providing disease-directed and supportive care options for patients with advanced cancer throughout the continuum of care. Building on ASCO's prior statements on end-of-life care (1998) and palliative care (2009), this article reviews the evidence for improved patient care in advanced cancer when patients' individual goals and preferences for care are discussed. It outlines the goals for individualized care, barriers that currently limit realization of this vision, and possible strategies to overcome these barriers that can improve care consistent with the goals of our patients and evidence-based medical practice.