Best palliation in advanced cancer is often achieved by treating the cancer

As a practising oncologist, I am of course well aware that chemotherapy causes side effects. I also see the effects of metastatic cancer such as severe bone pain. Often the best palliation is achieved by treating the cancer, with radiotherapy or drug treatment, including chemotherapy, and this will be the main aim of treatment. In general, modest survival prolongation is not the main aim of palliative chemotherapy, although it will often be a spin off benefit of a good response.

I have never had a GP trainee attend my oncology clinic in almost 20 years as a consultant. Given Spence’s views,1 there would seem to be something of a hole in GP training if the perceived view is that oncologists persist in giving toxic treatments for borderline or no benefit. Spence also seems to think we are unable to broach the subject of end of life care and opt instead to treat with toxic drugs to cover up this deficit. I would be happy for Spence to join me in my clinic so he can see how oncologists approach the issue of palliating advanced cancer. We are well aware that patients are mortal, and managing how people die and helping them to die well is a large part of our job.