(ChemotherapyAdvisor) – Extra efforts are needed to address advance care planning for patients with advanced malignances referred to a phase 1 clinical trials program, research at the MD Anderson Cancer Center suggests. In an article published in the Journal of Clinical Oncology online July 9, a survey found many patients “wanted to avoid” the topic, “because they had come to the phase 1 clinic for cancer therapy,” the authors reported.

Patients with advanced cancer refractory to standard therapy “are the prototypical candidates for phase 1 clinical trials,” the article states. A recent study found this cohort of patients had a median overall survival of 9.0 months after referral to MD Anderson’s phase 1 clinical trials program.

Of the 435 individual approached, 215 (49%) returned the completed or partially completed investigator-designed survey; most (69%) were still hopeful about their future.

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“Approximately 42% of patients (n=90) reported having a living will, 46% had a medical power of attorney (n=98), and 19% had a do-not-resuscitate (DNR) order (n=40),” the authors wrote. “Having a DNR order in place was significantly more common in individuals who had a living will and/or a medical power of attorney.”

Approximately 20% of participants (n=43) had not discussed advance care planning; of these 59% wanted to discuss this with their physician. Approaches might include interviews with the patient, family members, and health care providers.

“Although we should avoid unnecessary physical suffering, emotional distress, and medical futility, we must respect our patients’ personal values, religious beliefs, and willingness to take risks at the end of life, while providing them with an invitation to discuss important issues. It would be beneficial to translate the findings of this study into daily clinical practice by discussing advance care planning early to allow patients to be better prepared for end-of-life care,” they concluded.