This study identified two beliefs regarding the patient’s acceptance of death among breast surgeons treating recurrent/metastatic cancer, and constructed a model of the terminal stage treatment process, consisting mainly of palliative chemotherapy and patient-doctor communication, based on relationships with these two beliefs. We propose that doctors who hold these beliefs, even partially, heed three points in the course of clinical practice: the need to share the patient’s value system, the need to consider how best to make use of the palliative care team, and the need to be conscious of individual differences in what the patient regards as a good death. We believe this would contribute to the ability of doctors, who make decisions about chemotherapy at the end stage for breast cancer patients in the absence of clearly-defined guidelines, to offer patients optimal care.


The authors wish to thank the 21 breast surgeon informants who took part in this research for sharing their experiences and opinions. This work was supported by ‘Support of Academic Researchers from The Uehiro Foundation on ethics and education’.

Continue Reading

Author contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.


Dr Taichi Hatta reports grants from Supporting Program for InteRaction-based Initiative Team Studies (SPIRITS), Research Institute of Science and Technology for Society (RISTEX), outside the submitted work. The authors report no other conflicts of interest in this work.

Reina Ozeki-Hayashi,1 Misao Fujita,2 Atsushi Tsuchiya,3 Taichi Hatta,2 Eisuke Nakazawa,1 Yoshiyuki Takimoto,1 Akira Akabayashi1,4
1Department of Biomedical Ethics, The University of Tokyo Faculty of Medicine, Tokyo, Japan; 2Uehiro Research Division for iPS Cell Ethics, Center for iPS Cell Research and Application Kyoto University, Kyoto, Japan; 3Industrial and Social Science, Tokushima University Graduate School of Technology, Tokushima, Japan; 4Division of Medical Ethics, Department of Population Health, New York University School of Medicine, New York, NY, USA


1. Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC. Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol. 2004;22(2):315–321. doi:10.1200/JCO.2004.08.136

2. Lee HS, Chun KH, Moon D, Yeon HK, Lee S, Lee S. Trends in receiving chemotherapy for advanced cancer patients at the end of life. BMC Palliat Care. 2015;14:4. doi:10.1186/s12904-015-0001-7

3. Liu TW, Chang WC, Wang HM, et al. Use of chemotherapy at the end of life among Taiwanese cancer decedents, 2001-2006. Acta Oncol. 2012;51(4):505–511. doi:10.3109/0284186X.2011.653440

4. Schildmann J, Tan J, Salloch S, Vollmann J. “Well, I think there is great variation … ”: a qualitative study of oncologists’ experiences and views regarding medical criteria and other factors relevant to treatment decisions in advanced cancer. Oncologist. 2013;18(1):90–96. doi:10.1634/theoncologist.2012-0206

5. The AM, Hak T, Koeter G, van Der Wal G. Collusion in doctor-patient communication about imminent death: an ethnographic study. BMJ. 2000;321(7273):1376–1381. doi:10.1136/bmj.321.7274.1450

6. Laryionava K, Heussner P, Hiddemann W, Winkler EC. Framework for timing of the discussion about forgoing cancer-specific treatment based on a qualitative study with oncologists. Support Care Cancer. 2015;23(3):715–721. doi:10.1007/s00520-014-2416-8

7. Corbin JSA Basics of qualitative research (3rd ed.): techniques and procedures for developing grounded theory. In: Thousand Oaks, California; 2008. Available from: Accessed December 18, 2018.

8. Lincoln YS, Guba YSLEG, Guba EG, Publishing S. Naturalistic Inquiry. Thaousand Oaks, CA: SAGE Publications; 1985.

9. Creswell JW. Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Thaousand Oaks, CA: SAGE Publications; 2003.

10. Pirl WF, Greer JA, Irwin K, et al. Processes of discontinuing chemotherapy for metastatic non-small-cell lung cancer at the end of life. J Oncol Pract. 2015;11(3):e405–412. doi:10.1200/JOP.2014.002428

11. Dworkin G, Sugden SJB. Paternalism. Monist. 1972;56(1):64–84. doi:10.5840/monist197256119

12. Lyckholm LJ. Thirty years later: an oncologist reflects on Kubler-Ross’s work. Am J Bioethics. 2004;4(4):W29–31. doi:10.1080/15265160490908059

13. Zimmermann C. Acceptance of dying: a discourse analysis of palliative care literature. Soc Sci Med. 2012;75(1):217–224.

14. Detering KM, Hancock AD, Reade MC, Silvester W. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ. 2010;340:c1345. doi:10.1136/bmj.c293

15. Bernacki RE, Block SD. Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med. 2014;174(12):1994–2003. doi:10.1001/jamainternmed.2014.5271

16. Fallowfield L, Jenkins V. Communicating sad, bad, and difficult news in medicine. Lancet. 2004;363(9405):312–319. doi:10.1016/S0140-6736(03)15392-5

17. Studer RK, Danuser B, Gomez P. Physicians’ psychophysiological stress reaction in medical communication of bad news: A critical literature review. Int J Psychophysiol. 2017;120:14–22. doi:10.1016/j.ijpsycho.2017.06.006

18. Temel JS, Greer JA, Admane S, et al. Longitudinal perceptions of prognosis and goals of therapy in patients with metastatic non-small-cell lung cancer: results of a randomized study of early palliative care. J Clin Oncol. 2011;29(17):2319–2326. doi:10.1200/JCO.2010.32.4459

19. Bergqvist J, Strang P. The will to live – breast cancer patients perceptions’ of palliative chemotherapy. Acta Oncol. 2017;56(9):1168–1174. doi:10.1080/0284186X.2017.1327719

20. Buiting HM, Terpstra W, Dalhuisen F, et al. The facilitating role of chemotherapy in the palliative phase of cancer: qualitative interviews with advanced cancer patients. PLoS One. 2013;8(11):e77959. doi:10.1371/journal.pone.0077959

Source: Breast Cancer: Targets and Therapy.
Originally published July 17, 2019.

READ FULL ARTICLE Curated publisher From Dovepress