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Ethical issues in patient-physician communication about therapy for cancer: professional responsibilities of the oncologist.

Value in cancer care from a patient-centered perspective not only requires full oncologist-to-patient communication of information about potential treatments, but also imbues in the oncologist a responsibility to evaluate the value of cancer therapies and to offer to patients only those potential therapies that are appropriate for the patient. A case is presented in which the possibility of a low-probability treatment presented without adequate context or advice led to a prolonged, unsatisfying death for a young person with advanced cancer. The professional responsibility of the oncologist includes provision of care based on wise, cost-effective management aimed at meeting the needs of the individual patient. The oncologist has the clinical knowledge, is aware of a patient's clinical details, and has the relationship with the patient that permits understanding his or her values in order to guide cancer care decisions. The oncologist must identify the spectrum of treatments that are indicated for the patient, understand patient preferences and goals in order to inform the patient about options, and advise the patient concerning choice of cancer care. Oncologists as a professional group can ensure the use of standardized outcome measures, promote communication of prognosis and goals in order to guide optimal cancer care choices, and ensure appropriate patient selection and reasonableness in the cost per benefit increment of treatments. In this way, oncologists can ensure value in cancer care.