“Qualitative analysis of practices in thoracic oncology regarding the discontinuation of oncological treatments and coordination with the palliative care teams”

Recent advances in first-line therapies for metastatic non-small cell lung cancer (NSCLC) have improved overall survival, yet response rates diminish across successive treatment lines. Oncologists are therefore often confronted with the question of discontinuing systemic therapy, a process that raises medical, relational, and ethical challenges. Despite the recognized detrimental impact of end-of-life chemotherapy on quality of life, few studies have explored physicians’ practices and decision-making processes regarding treatment discontinuation and the integration of palliative care. We conducted a qualitative study based on semi-structured interviews with thoracic oncologists from three hospitals in Normandy, France. Interviews were recorded and transcribed verbatim. A descriptive analysis was conducted, drawing on grounded theory methodology. Data collection and analysis were performed iteratively, allowing categories and a theoretical model to emerge. Due to data saturation, 10 out of 14 interviews were conducted. Analysis highlighted two meta-categories: experiences and perceptions, and responses. - Experiences and perceptions: Physicians described anticipatory communication strategies, introducing the possibility of discontinuation from earlier treatment lines. Decisions were framed using objective clinical arguments to avoid subjective projection. Physicians reported ambivalent experiences: conviction when discontinuation was clearly beneficial, but also doubt, frustration, or a sense of therapeutic failure, particularly in younger patients. Patients’ reactions varied, from acceptance (often facilitated by clinical decline) to resistance or requests for second opinions. Families could act as either facilitators or barriers. The term “palliative care” was consistently associated by patients with imminent death. - Responses: Oncologists developed strategies to prevent perceived abandonment, including continued follow-up after discontinuation, transitional therapeutic breaks, or minimal treatments for symbolic continuity. The role of multidisciplinary tumor boards was considered limited, except for complex or young cases. All participants underlined the supportive role of palliative care teams in managing symptoms, maintaining continuity, and alleviating the burden on oncologists. Early integration was viewed as beneficial, though hindered by territorial disparities and resource limitations. Discontinuation of systemic therapy in thoracic oncology is less a therapeutic withdrawal than a relationally protected transition, conceptualized as a “therapeutic transition that protects relational commitment”. Early and equitable integration of palliative care appears essential to support patients, families, and oncologists during this critical phase, ensuring continuity and mitigating the risk of perceived abandonment.