Palliative care consultants’ ethical concerns with advanced cancer patients participating in phase 1 clinical trials. A case study

Abstract

Patients with advanced cancer often continue to choose aggressive interventions and/or treatments up until the final stages of life. This clinical approach may compromise the preservation of a patient’s quality of life, and secondarily, contributes to higher healthcare costs. Therefore, the ethics of enrolling terminal cancer patients in clinical trials which are testing new, aggressive chemotherapy agents requires careful discussion between the Oncology and the Palliative Care team. We present the case of a patient with stomach cancer admitted to a clinical trial at a very advanced stage of her disease. A number of clinical and ethical difficulties encountered by the PC team are discussed as well as possible solutions.

Keywords:

• Palliative care
• Phase 1 clinical trial
• Chemotherapy
• Advanced cancer
• Vulnerability
• Ethical issues
• Moral distress
• Decision making

ORCID

Nunziata Comoretto http://orcid.org/0000-0002-6705-8499

Maria Arantzamendi http://orcid.org/0000-0003-2406-0668

Carlos Centeno http://orcid.org/0000-0003-3395-7039