Ethical issues related to chemotherapy in patients with gastric cancer

Abstract

Postoperative chemotherapy and radiation therapy is standard
care in high risk patients who had undergone a curative
resection of the primary tumor. Best survival results are
achieved with three-drug regimens containing FU, an anthracycline,
and cisplatin (ECF), although the recently presented
REAL-2-trial, demonstrated a significant survival benefit for
EOX (epirubicin, oxaliplatin, capecitabine) over ECF. Consequently,
chemotherapy could be offered to some proportion of
patients with advanced gastric cancer taking into account the
results of the available clinical trials. Neo-adjuvant chemotherapy
has the ability to downsize gastric tumours. It remains
unclear however, how the neoadjuvant therapy may be
integrated into the multimodality management of localized
gastric cancer. According to recent studies, adjuvant
chemotherapy resulted in a significant survival benefit in patients
with gastric cancer. However, others did not recommend
adjuvant chemotherapy as routine therapy. A lot of case
reports with metastatic cancer treated with S-1 plus cisplatin
have appeared in the recent literature with promising results.
Therefore, such treatment could be offered to some patients
with metastatic gastric cancer as a last hope. Patients
with peritoneal dissemination should be submitted to chemotherapy
after full explanation of the expected results. The use
of chemotherapy in patients with linitis plastica remains controversial.
Chemotherapy should be offered to patients with
gastric cancer at advanced age. Nutrition therapy in advanced
gastric cancer might offer improved quality of life especially to
those with gastric outlet obstruction despite the associated increased
cost. Other parameters related to the decision to give
chemotherapy or not to gastric cancer patients are related to
the role of patient relatives, the doctors' training and availability,
the psychological support of the patient, the doctor's-patient
relationships, and the right of the patient to receive the
best available medical treatment. These parameters must be
taken into account where dealing with a patient with gastric
cancer who is a candidate for chemotherapy.
Key words: Gastric cancer, Chemotherapy, Ethics