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Curative vs Palliative Intent — SCE Medical Oncology MCQ

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HardSupportive & Palliative OncologyCurative vs Palliative IntentSCE Medical Oncology

A patient with rapidly progressive metastatic cancer has ECOG performance status 3, largely from potentially reversible tumour symptoms. Systemic treatment has a modest chance of a prompt response but substantial toxicity, and the net benefit is uncertain. Which plan best supports a proportionate shared decision?

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Correct answer: C — Agree a time-limited trial with explicit benefit, toxicity and stopping criteria

A time-limited treatment trial with prospective symptom, function, toxicity and stopping criteria makes the uncertainty transparent and proportionate. Agree immediate standard-dose treatment with toxicity review after three cycles: the uncertain early net benefit needs an earlier explicit stopping assessment. Agree dose-reduced treatment with radiological review after six cycles: dose reduction and late imaging do not define a meaningful benefit threshold. Agree symptom-directed care with reconsideration of treatment after functional recovery: this is reasonable in some cases but does not test the stated possibility of a prompt tumour response. Agree standard treatment with continuation governed by patient preference at each cycle: preference matters, but measurable benefit and toxicity criteria are still needed.

Reference: Time-limited trials near the end of life (Published January 2012): https://jamanetwork.com/journals/jama/article-abstract/1104450; GMC decision making and consent (Effective November 2020; current GMC standard): https://www.gmc-uk.org/professional-standards/the-professional-standards/decision-making-and-consent