Considerations for cancer-directed therapy in advanced childhood cancer

Abstract

Cancer-directed therapy encompasses any modality utilized with the goal of controlling cancer. Research among adults with advanced cancer suggests that adults who understand that their cancer is incurable are less likely to continue cytotoxic cancer-directed therapy. However, novel classes of targeted and immunologic therapies are rapidly changing treatment paradigms in advanced malignancies. These agents may alter previously accepted prognostic estimates for some advanced cancers by facilitating life extension through cancer control without achieving cancer eradication. Similarly, our understanding of illness trajectories in advanced childhood cancers is increasingly complex and necessitates nuanced and serial prognostic discussions. Research among families of children with advanced cancer suggests that preferences and priorities vary and that cancer-directed therapy may convey benefits as well as burdens. In summary, detailed understanding of tumor biology, available therapies and healthcare system constraints, careful symptom monitoring, and repeated assessments of patient and parent understanding, preferences, and goals should guide decision-making with regard to selecting, continuing, or discontinuing cancer-directed therapy.