Abstract
Participating in clinical studies constitutes an important aspect in oncology, even in incurable diseases, and is indispensable for improving anticancer therapy with respect to efficacy and side effects. Nevertheless, numerous medical and ethical problems can be identified in clinical situations where transition to palliative care may interfere with the enrollment in early phase clinical trials and the hopeful expectations they generate. In this chapter we introduce different moral points of view from which one can analyze the normative problems and issues related to the decision whether a patient with advanced cancer should enter an early phase clinical trial. We then address key ethical issues using paradigmatic cases that raise ethical questions: (1) prerequisites for the informed consent, (2) conflict of obligations, and (3) conflicts of interest in the context of early phase trial participations of advanced-cancer patients. We then discuss possible strategies and limitations for reconciling a clinical research-oriented and palliative care perspective with regard to patients with advanced cancer. We conclude with specific principles of how these key ethical issues can best be addressed.
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Notes
- 1.
While we do not view the question of “palliative care versus phase 1 trial” as one to which there are only mutually exclusive answers, we pursue this dichotomy for most parts of the article because in our experience this reflects the perception of many patients and clinicians who are faced with the situation in current clinical practice.
- 2.
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Winkler, E.C., Schildmann, J. (2015). Palliative Care for Patients Participating in Experimental or Clinical Oncology Studies. In: Alt-Epping, B., Nauck, F. (eds) Palliative Care in Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-46202-7_17
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