Résumé
Le cancer du sein métastatique est une des maladies les plus chimio-sensibles, pour laquelle les traitements spécifiques permettent d’obtenir une longue survie. En pratique clinique, les lignes de chimiothérapie se succèdent régulièrement au-delà de la troisième ligne mais avec une efficacité qui s’épuise dans le temps. La poursuite d’une chimiothérapie qui n’est plus efficace entra?ne plusieurs conséquences négatives. Le patient peut subir inutilement des effets secondaires, ce qui va à l’encontre du principe éthique de non-malfaisance. Le désir de protection bienveillante invoquée pour épargner le stress de l’annonce de l’échec des chimiothérapies peut avoir pour corollaire l’isolement relationnel du patient, qui constate que la situation médicale s’aggrave sans explication médicale. Cela peut engendrer un sentiment d’angoisse et d’oppression non verbalisé. Pour les soignants, l’administration de traitements inefficaces et toxiques est source de sentiments d’échec et de culpabilité. L’absence de communication autour de la gravité du pronostic empêche de mettre en place un projet de soins palliatifs de qualité. Pour la société, ces traitements inutiles engendrent un surco?t, et il est montré que l’absence d’intégration du pronostic sombre est l’élément qui détermine le plus la demande de soins intensifs pour les patients suivis en cancérologie (1).
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Bouleuc, C. (2010). Limites subjectives de la prise en charge des patientes métastatiques. Quand les traitements oncostatiques laissent la place aux traitements palliatifs. In: Cancer du sein en situation métastatique. Springer, Paris. https://doi.org/10.1007/978-2-8178-0076-9_31
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DOI: https://doi.org/10.1007/978-2-8178-0076-9_31
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