1741P - Ethically-sensitive clinical scenarios in adult patients with sarcomas: A real-world single-institution survey and a classification attempt

Background

Little research has been made on real-world clinical scenarios of potential ethical relevance in specific cancers, including sarcomas.

Methods

Our sarcoma multidisciplinary tumor board (MTB) discusses all cases of adult patients with soft tissue sarcomas, bone sarcomas and GIST selected by the clinical oncologist in charge as deserving a multidisciplinary discussion. Over a 1-yr interval, all discussed cases were filtered by a group of senior and junior experts in bioethics and sarcomas in order to highlight those of potential ethical concern, i.e. whenever a problematic conflict could be envisaged between the ethical principles of beneficence, non-maleficence, autonomy and justice. These cases were retrospectively reviewed, and an attempt was made to group them into distinct ethical scenarios.

Results

From January to December 2023, 327 sarcoma cases were discussed by our MTB. Forty-one cases (12%) were prospectively or retrospectively selected as carrying possible ethical relevance. Among them, the following clinical scenarios were identified (total >100% since scenarios are not mutually exclusive): 1. ethically-relevant uncertainty about a diagnostic/treatment option (46%); 2. best treatment option at a high-risk of complications of problematic acceptance (5%); 3. controversial futility (17%); 4. problematic trade-off between quality and quantity of life (17%); 5. problematic management of patient dissent (15%); 6. clinical disagreement of potential ethical concern (10%); 7. problematic communication of all clinical implications to the individual patient (15%). 8. controversial enrolment of an eligible patient in a clinical trial or trial requirements of ethical concern in the individual patient (2%); 9. best clinical option conflicting with social/economical constraints (0.3%); 10. bedside rationing, or perception of implicit rationing of scarce resources (2%).

Conclusions

A non-negligible incidence of ethically-relevant clinical cases was observed. Sarcoma centres should be aware of specific ethical implications possibly affecting their everyday practice. Paradigmatic clinical cases for each of the ten clinical scenarios proposed herein will be presented.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.