Quality of life vs. treatment intensity vs. side effects in patients with gastrointestinal cancer in the palliative situation

Background Patients with gastrointestinal (GI) cancer frequently receive systematic palliative therapy, and in many cases over a long period of time. Considering demographic change, we can expect that weighing the benefits and harms in each case will become more complex. Materials and methods The paper is based on a literature review regarding the systemic therapeutic options for patients with GI cancer, a retrospective analysis of routinely used patient self-assessment questionnaires from the Department of Radiation Oncology of Wurzburg University Hospital, and a presentation of selected and relevant recommendations from the S3 guideline on palliative care for patients with incurable cancer. Results The most efficacious systemic therapy options for patients with GI cancer in the palliative setting is not necessarily the treatment with the most severe side effects, particularly when novel targeted treatment strategies are concerned. The well-known discrepancy already known in the literature between the physician's documented treatment intention and the patient's self-assessment was confirmed: 15/26 patients treated in palliative intent incorrectly assumed a therapeutic goal of cure (57.7%). The updated S3 guideline on palliative care for patients with incurable cancer recommends the active participation of patients in setting the treatment goals and to focus on realistic therapy intentions. Strengthening the patient's perspective in this process could be achieved by utilizing the suggestions for the preparation of a physician's consultation that are entailed in the patient guideline "Palliative care for patients with incurable cancer". Conclusion In addition to assessing the benefits and harms of a systematic palliative therapy based on the individual patient, physicians should also discuss the treatment goal with their patients in order to arrive at a common therapeutic goal.