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Goals of Care — SCE Medical Oncology MCQ

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EasySupportive & Palliative OncologyGoals of CareSCE Medical Oncology

A 65-year-old woman with metastatic pancreatic cancer has rapidly deteriorating performance status. She is now ECOG PS 3 and spending >50% of the day in bed. She asks her oncologist about continuing second-line chemotherapy. What is the most appropriate response?

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Correct answer: E — Discuss that the risks of chemotherapy now likely outweigh the benefits, and recommend focusing on best supportive care and symptom management

For patients with advanced cancer and poor performance status (ECOG PS 3-4), the evidence consistently shows that systemic chemotherapy is unlikely to provide benefit and significantly increases toxicity, hospital admissions and treatment-related death. Honest communication about the shift in goals from disease-directed therapy to symptom management is a core oncological competency. Early palliative care integration (demonstrated in the Temel et al NEJM 2010 trial) improves quality of life and may even extend survival.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer