A taxonomy of the factors contributing to the overtreatment of cancer patients at the end of life. What is the problem? Why does it happen? How can it be addressed?

Abstract

Many patients with cancer approaching the end of life (EOL) continue to receive treatments that are unlikely to provide meaningful clinical benefit, potentially causing more harm than good. This is called overtreatment at the EOL. Overtreatment harms patients by causing side-effects, increasing health care costs, delaying important discussions about and preparation for EOL care, and occasionally accelerating death. Overtreatment can also strain health care resources, reducing those available for palliative care services, and cause moral distress for clinicians and treatment teams. This article reviews the factors contributing to the overtreatment of patients with cancer at the EOL. It addresses the complex range of social, psychological, and cognitive factors affecting oncologists, patients, and patients' family members that contribute to this phenomenon. This intricate and complex dynamic complicates the task of reducing overtreatment. Addressing these driving factors requires a cooperative approach involving oncologists, oncology nurses, professional societies, public policy, and public education. We therefore discuss approaches and strategies to mitigate cultural and professional influences driving overtreatment, reduce the seduction of new technologies, improve clinician-patient communication regarding therapeutic options for patients approaching the EOL, and address cognitive biases that can contribute to overtreatment at the EOL.

Keywords: advanced cancer; communication; end-of-life care; informed consent; overtreatment; palliative care.

Figure 1

Factors contributing to overtreatment at the end of life.