La agresividad terapéutica y la oncología líquida

  1. F. J. Barón Duarte
  2. M. S. Rodríguez Calvo
  3. J. R. Amor Pan
Journal:
Cuadernos de bioética

ISSN: 1132-1989 2386-3773

Year of publication: 2017

Volume: 28

Issue: 92

Pages: 71-81

Type: Article

More publications in: Cuadernos de bioética

Abstract

Aggressiveness criteria proposed in the scientific literature a decade ago provide a quality judgment and are a reference in the care of patients with advanced cancer, but their use is not generalized in the evaluation of Oncology Services. In this paper we analyze the therapeutic aggressiveness, according to standard criteria, in 1.001 patients with advanced cancer who died in our Institution between 2010 and 2013. The results seem to show that aggressiveness at the end of life is present more frequently than experts recommend. About 25% of patients fulfill at least one criterion of aggressiveness. This result could be explained by a liquid Oncology which does not prioritize the patient as a moral subject in the clinical appointment. Medical care is oriented to necessities and must be articulated in a model focused on dignity and communication. Its implementation through Advanced Care Planning, consideration of patient’s values and preferences, and Limitation of therapeutic effort are ways to reduce aggressiveness and improve clinical practice at the end of life. We need to encourage synergic and proactive attitudes, adding the best of cancer research with the best clinical care for the benefit of human being, moral subject and main goal of Medicine.

Bibliographic References

  • Andreis F, Rizzi A, Rota L, Meriggi F. et al. “Chemotherapy use at the end of life. A retrospective single center experience analysis”. Tumori (2011) 97: 30-34.
  • Barón F.J. La agresividad terapéutica y los tratamientos limitados en el tiempo en pacientes oncológicos al final de la vida: fundamentos éticos y aplicación clínica. Tesis Doctoral. Universidad de Santiago de Compostela (2015).
  • Bauman, Z. Modernidad líquida, Fondo de Cultura Económica México, (2003) 82.
  • Borrell-Carrió F, Suchman AL, Epstein Ronald M. “The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry”. Ann Fam Med (2004) 2: 576-582.
  • Bradford R. Hirsch and Amy P. Abernethy. “Structured Decision-Making: Using Personalized Medicine to Improve the Value of Cancer Care”. J Pers Med (2013) 3:1-13.
  • Camps V. Elogio de la Duda. Ed. Arpa. Barcelona 2016, 12-49.
  • Cassel E. La persona como sujeto de la medicina. Cuadernos de la Fundación Víctor Grifols nº 19. Barcelona. 2009, 16.
  • Cherny N.H, de Vries, G.E, Emanuel L. et al. Words Matter: Distinguishing “Personalized Medicine” and “Biologically Personalized Therapeutics. J Natl Cancer Inst (2014) 106(12) DOI:10.1093/jnci/dju321
  • Earle CC, Park ER, Lai B, Ayanian JZ, et al. “Identifying Potential Indicators of the Quality of End-of-Life Cancer Care From Administrative Data”. J Clin Oncol. (2003) 21:1133-1138.
  • Engel GL. “The need for a new medical model: a challenge for biomedicine”. Science (1977) 196:129-36.
  • González-Angulo A.M., Hennessy Bryan T.J, and Mills Gordon B. “Future of Personalized Medicine in Oncology: A Systems Biology Approach”. J Clin Oncol (2010) 28:2777-2783.
  • Hurssel E. La crisis de las ciencias europeas y la fenomenología trascendental. Ed. Prometeo. Buenos Aires 2008, 49.
  • Jonas H. Por qué la técnica moderna es objeto de la filosofía. Técnica, Medicina y ética. Barcelona. Paidós, 1985, 30.
  • Jackson V. A, Mack J., and Matsuyama R. A. “Qualitative study of oncologist’s’ approaches to end of life care”. J Palliat Med (2008) 893–906.
  • Kao S, Shafiq J, Vardy J, and Adams D: “Use of chemotherapy at end of life in oncology patients”. Ann Oncol (2009) 20:1555–1559.
  • Kelly M.C, Pritchard I.K. Personalized Medicine: What Exactly Is It and Can We Truly Measure It? J Clinical Oncology 30: 2173-2174, 2012.
  • Kleinnman, AM. “What kind of model for the anthropology of Medical System?” Am. Anthropologist (1977) 80: 661-665.
  • Martínez Hernaez, A. Símbolos, Cuerpos y Aflicciones, En: Antropología médica. Teorías sobre la cultura, el poder y la enfermedad. Angel Martinez Hernaez ed. Antropos. Barcelona. (2008), 01-102.
  • National Cancer Policy Board: Ensuring Quality Cancer Care. Washington, DC, National Academy Press, 1999
  • Organización Médica Colegial. Grupo de trabajo de Atención médica al final de la vida. 2009. Disponible en <https://www.cgcom.es/.../Atencion%20Medica%20al%20final%20de%20la%20vida.pdf>
  • Panabieres and K. Pantel. “Circulating Tumor Cells: Liquid Biopsy of Cancer”. C. A. Clinical Chemistry (2013) 59:110–118.
  • Peppercorn J.M, Smith T. J., Helft P.R. et. al. “American Society of Clinical Oncology Statement: Toward Individualized Care for Patients with Advanced Cancer”. J Clin Oncol (2011) 29:755-760.
  • Quill T.E. Holloway, R. “Time-limited trials near the end of life”, JAMA (2011) 306:13, 1483-1484.
  • Santiago, Manuel De. “Identidad de la Medicina en el pensamiento de Edmund D. Pellegrino” Cuadernos de Bioética. 2016; 27(89): 29-51.
  • Sanz Ortiz J. “Chemotherapy at the end of life: up until when?” Clin Transl Oncol (2012) 67:667–674.
  • Seom.org/seomcms/images/stories/recursos/LA_CIFRAS_DEL_CANCER_EN_2016.pdf
  • Surbone A.. Professionalism in Global, Personalized Cancer Care: Restoring Authenticity and Integrity. 2013 ASCO EDUCATIONAL BOOK | asco.org/edbook
  • Torralba, F. Filosofía de la Medicina. En torno a la obra de E.D. Pellegrino. Instituto Borja de Bioética. Barcelona 2001
  • Wulff H.R, Pedersen S.A, Rosenberg R. El Modelo Mecánico. En Introducción a la Filosofía de la Medicina. Triacastela. Madrid, (2002) 94.