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Withdrawal of anticancer therapy in advanced disease: a systematic literature review

Overview of attention for article published in BMC Cancer, November 2015
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (93rd percentile)
  • High Attention Score compared to outputs of the same age and source (98th percentile)

Mentioned by

news
1 news outlet
twitter
27 tweeters
facebook
1 Facebook page

Citations

dimensions_citation
30 Dimensions

Readers on

mendeley
54 Mendeley
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Title
Withdrawal of anticancer therapy in advanced disease: a systematic literature review
Published in
BMC Cancer, November 2015
DOI 10.1186/s12885-015-1862-0
Pubmed ID
Authors

G. Clarke, S. Johnston, P. Corrie, I. Kuhn, S. Barclay

Abstract

Current guidelines set out when to start anticancer treatments, but not when to stop as the end of life approaches. Conventional cytotoxic agents are administered intravenously and have major life-threatening toxicities. Newer drugs include molecular targeted agents (MTAs), in particular, small molecule kinase-inhibitors (KIs), which are administered orally. These have fewer life-threatening toxicities, and are increasingly used to palliate advanced cancer, generally offering additional months of survival benefit. MTAs are substantially more expensive, between £2-8 K per month, and perceived as easier to start than stop. A systematic review of decision-making concerning the withdrawal of anticancer drugs towards the end of life within clinical practice, with a particular focus on MTAs. Nine electronic databases searched. PRISMA guidelines followed. Forty-two studies included. How are decisions made? Decision-making was shared and ongoing, including stopping, starting and trying different treatments. Oncologists often experienced 'professional role dissonance' between their self-perception as 'treaters', and talking about end of life care. Why are decisions made? Clinical factors: disease progression, worsening functional status, treatment side-effects. Non-clinical factors: physicians' personal experience, values, emotions. Some patients continued treatment to maintain 'hope', often reflecting limited understanding of palliative goals. When are decisions made? Limited evidence reveals patients' decisions based upon quality of life benefits. Clinicians found timing withdrawal particularly challenging. Who makes the decisions? Decisions were based within physician-patient interaction. Oncologists report that decisions around stopping chemotherapy treatment are challenging, with limited evidence-based guidance outside of clinical trial protocols. The increasing availability of oral MTAs is transforming the management of incurable cancer; blurring boundaries between active treatment and palliative care. No studies specifically addressing decision-making around stopping MTAs in clinical practice were identified. There is a need to develop an evidence base to support physicians and patients with decision-making around the withdrawal of these high cost treatments.

Twitter Demographics

The data shown below were collected from the profiles of 27 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 54 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Spain 1 2%
Denmark 1 2%
Unknown 52 96%

Demographic breakdown

Readers by professional status Count As %
Other 9 17%
Student > Ph. D. Student 7 13%
Student > Bachelor 7 13%
Researcher 7 13%
Student > Master 6 11%
Other 18 33%
Readers by discipline Count As %
Medicine and Dentistry 25 46%
Unspecified 9 17%
Nursing and Health Professions 6 11%
Economics, Econometrics and Finance 3 6%
Agricultural and Biological Sciences 2 4%
Other 9 17%

Attention Score in Context

This research output has an Altmetric Attention Score of 24. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 30 April 2018.
All research outputs
#613,417
of 12,875,491 outputs
Outputs from BMC Cancer
#90
of 4,783 outputs
Outputs of similar age
#19,122
of 278,300 outputs
Outputs of similar age from BMC Cancer
#15
of 758 outputs
Altmetric has tracked 12,875,491 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 95th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 4,783 research outputs from this source. They receive a mean Attention Score of 3.9. This one has done particularly well, scoring higher than 98% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 278,300 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 93% of its contemporaries.
We're also able to compare this research output to 758 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 98% of its contemporaries.