The intent of metastatic disease treatment is palliative, not curative, so we try to prolong life and provide quality of life as much as we can, said Hatem Soliman, MD, medical director of the Clinical Trials Office, Moffitt Cancer Center.
Hatem Soliman, MD, medical director of the Clinical Trials Office, Moffitt Cancer Center, discusses the short- and long-term priorities when treating patients with metastatic diseases, such as including patients in the decision-making process and trying to provide quality of life.
When considering a patient with metastatic disease for targeted treatment, what are both your short- and long-term priorities? How do these change if a patient has a terminal cancer?
When we're dealing with patients who have metastatic disease, it's often a very difficult discussion to have with patients, particularly when they're initially diagnosed. A lot of our treatment discussions do center around goals of care and what we can realistically offer the patient in terms of benefits from treatment, and how that factors into what they want to do with their time and how it fits in with their lifestyle and their obligations.
In terms of the short-term priorities for patients with metastatic disease, we want to have that initial discussion to be able to make a joint decision about what treatment algorithm or regimen would make the most sense for them. Also what they're comfortable with, with regards to side effects and the way that the medication is administered and other factors that could play a role in them deciding what treatment they want to pursue.
We try to have a balanced discussion around the potential for benefit and risks so that the patient's fully informed around what treatment options they have, so that they can make the decision that's best for them, and also maybe in consultation with loved ones or family members, as well, when they feel they want that additional input or support from the people around them who are living with them and often may have to deal with some of the issues that may arise during treatment for their metastatic disease.
In terms of long-term priorities—because the intent of treatment for metastatic diseases is palliative, it's not curative—we're trying to prolong life as much as we can, but also with providing quality of life as well during that time that they're alive. We want them to be able to enjoy life and participate in their activities, even in some cases remaining functional and continuing to work when possible. Obviously, there's a prioritization of treatments that are less toxic but that can afford robust clinical benefits to allow those patients to have that freedom in order to continue to pursue their goals. That may involve still staying on the job, or spending more time with family, or doing trips that they want to do.
Long-term is trying to really align the overall strategy of the treatment, which is palliative, with figuring out what treatments allow them to be able to best live their lives and achieve those goals. And I think that consideration, when we realize that metastatic disease is a terminal cancer, does frame the priority differently for patients because they are looking to try to, in some cases, maximize the time that they have and prolong their survival as much as possible. But there are some patients, too, that say that they want to optimize quality over the quantity of time that they have left, so we try to adjust our treatment plans accordingly in order to match their priorities.