Ethical issues in diagnosis, treatment and care of cancer patients

Ethical issues in diagnosis, treatment and care of cancer patients



Ethical issues in diagnosis, treatment and care of cancer patients

Introduction

Cancer is a complex disease that, in orders to be tackled properly, requires an appropriate infrastructure support and should be evaluated within a multidisciplinary approach by skilled professionals. Approaching patients with malignant neoplasm is not an easy task in clinical practice, because it involves transmitting the medical information about their diagnosis, prognosis, risks and benefits of treatment, in addition to the possibility of disease progression. In such circumstances, the process of delivering bad news to patients is challenging, difficult and the sole responsibility of the physician. Bad news has been defined as any information which drastically and negatively affects an individual's view of his/her future. Moreover, assimilation of the information given by the physician and how patients experience their disease vary widely from individual to individual, involving several phenomena of the disease, such as pathological, psychosocial, anthropological, and socio cultural aspects, which must be understood.

Discussion and analysis

During the last several years, a consensus has developed concerning several ethical issues that arise in the treatment of pain in patients suffering with cancer. These issues range from the scandal of inadequate treatment of pain and the need for regularized clinical attention to pain, through the moral requirement for adequate professional education (both pharmacological and psychological), to agreement on the appropriateness of morphine doses adequate to relieve pain even with a small foreseen risk of hastening death. (Gadow, 2002, pp.99-101)

Cancer Maps

Maps are important tools in the geographic study of cancer; however, when producing and interpreting cancer maps, it is essential to consider how cancer is measured and displayed. Incidence, mortality, survival, prevalence, and stage of diagnosis are common measures of cancer disease outcomes. Typically, these measures are presented as rates, standardized by population size, age, sex, and race, as a means of accounting for the underlying demographic differences between regions. Since cancers are relatively rare diseases, data are often grouped across many years to provide sufficient stability to the rates. Some maps are descriptive (e.g., for purposes of surveillance), while others are used in spatial analyses undertaken to detect statistically significant patterns or possible associations with potential risk factors. An important issue is the spatial resolution of the cancer data. Depending on the purpose of the map, data may either be aggregated to some geographic level, for example, national, census units, postal districts, and so on, or the data may be mapped using the locations of individual persons (e.g., location of residence). In most applications the resolution is often determined by the availability of data, which is driven by confidentiality concerns, resulting in very few spatial studies of individual-level cancer. As a consequence, the modifiable areal unit problem (MAUP) must be considered, necessitating tests of whether results are consistent across different scales and levels of aggregation; without considering the MAUP, results should be interpreted cautiously. (Cassell, 2003, ...