{"id":2366,"date":"2026-05-11T07:00:25","date_gmt":"2026-05-11T07:00:25","guid":{"rendered":"https:\/\/blogs.bmj.com\/spcare\/?p=2366"},"modified":"2026-04-09T16:30:01","modified_gmt":"2026-04-09T16:30:01","slug":"are-we-treating-cancer-or-meaning-the-rise-of-advanced-pharmacotherapy","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/spcare\/2026\/05\/11\/are-we-treating-cancer-or-meaning-the-rise-of-advanced-pharmacotherapy\/","title":{"rendered":"Are We Treating Cancer or Meaning? The Rise of Advanced Pharmacotherapy"},"content":{"rendered":"<p><strong>Author: <em>Yusuke Sugama, MD, PhD<\/em><\/strong><\/p>\n<p><a href=\"https:\/\/blogs.bmj.com\/spcare\/files\/2026\/04\/Yusuke-Sugama.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-2365\" src=\"https:\/\/blogs.bmj.com\/spcare\/files\/2026\/04\/Yusuke-Sugama-200x300.jpg\" alt=\"\" width=\"135\" height=\"203\" srcset=\"https:\/\/blogs.bmj.com\/spcare\/files\/2026\/04\/Yusuke-Sugama-200x300.jpg 200w, https:\/\/blogs.bmj.com\/spcare\/files\/2026\/04\/Yusuke-Sugama-683x1024.jpg 683w, https:\/\/blogs.bmj.com\/spcare\/files\/2026\/04\/Yusuke-Sugama-768x1152.jpg 768w, https:\/\/blogs.bmj.com\/spcare\/files\/2026\/04\/Yusuke-Sugama-1024x1536.jpg 1024w, https:\/\/blogs.bmj.com\/spcare\/files\/2026\/04\/Yusuke-Sugama-1366x2048.jpg 1366w, https:\/\/blogs.bmj.com\/spcare\/files\/2026\/04\/Yusuke-Sugama-640x960.jpg 640w, https:\/\/blogs.bmj.com\/spcare\/files\/2026\/04\/Yusuke-Sugama.jpg 1575w\" sizes=\"auto, (max-width: 135px) 100vw, 135px\" \/><\/a><\/p>\n<p><em><span style=\"font-weight: 400\">Medical Oncologist, H<\/span><span style=\"font-weight: 400\">igashi Sapporo Hospital. ORCID iD: 0000-0003-2899-0512<\/span><\/em><\/p>\n<p><b>The Blurring Lines of Treatment and Care<\/b><\/p>\n<p><span style=\"font-weight: 400\">Have you ever prescribed a systemic therapy for an advanced cancer patient, fully aware that the biological benefit might be marginal, yet feeling it was somehow the \u201cright\u201d thing to do? When a patient says, \u201cContinuing this treatment keeps me going,\u201d we often find ourselves pausing. In those moments, I ask myself: am I still treating the tumour, or am I treating the patient\u2019s need for hope and connection?<\/span><\/p>\n<p><span style=\"font-weight: 400\">This everyday clinical dilemma points to a deeper issue in our current paradigm.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In advanced cancer, we have often treated without fully understanding what our treatments mean.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Pharmacological treatment in advanced, recurrent, and end-stage disease has long been part of routine clinical practice, yet it has rarely been defined as a distinct domain of care.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Decisions about whether to initiate or continue treatment have often relied on individual clinical judgement\u2014tacit knowledge, or even \u201cart.\u201d The purpose of such interventions has remained uncertain: to prolong survival, relieve symptoms, sustain hope, or respond to expectations within the clinical encounter.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Despite important attempts to conceptualise palliative chemotherapy, no unified framework has emerged. As a result, pharmacotherapy in advanced cancer remains an under-theorised area of practice.<\/span><\/p>\n<p><b>A Changing Landscape<\/b><\/p>\n<p><span style=\"font-weight: 400\">In recent years, however, the landscape has changed. Molecularly targeted therapies and immune checkpoint inhibitors have extended pharmacological intervention into stages of illness once considered beyond treatment.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Consider the following clinical realities:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400\">Clinical trials increasingly include patients with advanced disease.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Systemic therapies are sometimes used even within hospice care settings.\u00a0<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">These developments represent more than therapeutic expansion. They reveal a shift in the meaning of treatment itself.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The distinction between \u201ctreatment\u201d and \u201ccare\u201d is becoming increasingly blurred. It is no longer clear where one ends and the other begins, nor what counts as benefit when tumour response is unlikely, survival gain is marginal, or treatment derives its significance primarily from the meanings patients and families attach to it.<\/span><\/p>\n<p><b>The Limits of Existing Frameworks<\/b><\/p>\n<p><span style=\"font-weight: 400\">This evolving reality exposes the limits of our existing frameworks.\u00a0<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400\">Oncology: Traditionally oriented towards tumour control and survival, it offers limited guidance when biological benefit is uncertain, delayed, or modest.\u00a0<\/span><\/li>\n<li><span style=\"font-weight: 400\">Palliative care: Centred on symptom relief and quality of life, it does not fully capture the role that ongoing pharmacological treatment may play in shaping agency, hope, non-abandonment, and the lived experience of serious illness.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">The result is a clinical space not adequately described by either field alone.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Integration essentially means <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/25480826\/\"><span style=\"font-weight: 400\">delivering two distinct modes of care\u2014tumour-directed and symptom-directed\u2014in parallel<\/span><\/a><span style=\"font-weight: 400\">. Yet, in current practice, the pharmacological intervention itself has become an existential act. We are not just adding palliative care alongside oncology; the very nature of what it means to &#8216;treat&#8217; has transformed, demanding a new domain to evaluate it.<\/span><\/p>\n<p><b>Three Dimensions of a New Domain<\/b><\/p>\n<p><span style=\"font-weight: 400\">What is taking shape is not simply a better alignment of two existing disciplines, but the emergence of a recognisable domain of practice: advanced cancer pharmacotherapy. This domain is defined not only by the drugs it employs, but by the questions that govern their use.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Three dimensions are central:<\/span><\/p>\n<ul>\n<li><span style=\"font-weight: 400\">Biological validity: the extent to which an intervention is supported by tumour biology and the likelihood of meaningful response.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Clinical proportionality: the balance between possible benefit and burden, including toxicity, functional impact, and the demands treatment places on remaining life, especially when interventions may <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/26203912\/\"><span style=\"font-weight: 400\">actively compromise quality of life near the end of life<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Existential-relational meaning: the ways treatment intersects with patients\u2019 values, relationships, sense of agency, and understanding of what matters in the time that remains.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">Within such a framework, pharmacotherapy can no longer be judged by efficacy alone. It must also be understood as a practice situated within the broader human reality of advanced illness.<\/span><\/p>\n<p><b>Deciding What Treatment Means<\/b><\/p>\n<p><span style=\"font-weight: 400\">This reconceptualisation has important consequences. It challenges disease-centred models of indication and calls for context-sensitive decision making. It questions the dominance of endpoints such as survival alone,<\/span> <span style=\"font-weight: 400\">especially when patients consistently project expectations onto chemotherapy that <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/23094723\/\"><span style=\"font-weight: 400\">diverge entirely from its biological reality<\/span><\/a><span style=\"font-weight: 400\">. It invites the development of measures that better reflect meaning, experience, and proportionality.<\/span><\/p>\n<p><span style=\"font-weight: 400\">It also suggests that clinicians must be trained not only to prescribe treatment, but to interpret what treatment signifies. This is not a future possibility. It is already part of everyday practice.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In advanced cancer, pharmacotherapy is no longer only a biological intervention. It is also a relational and existential act.<\/span><\/p>\n<p><span style=\"font-weight: 400\">We are no longer deciding whether to treat. We are deciding what treatment means.<\/span><\/p>\n<p><b>Take Home Messages<\/b><\/p>\n<ul>\n<li><span style=\"font-weight: 400\">Pharmacotherapy in advanced cancer is evolving beyond the traditional frameworks of both oncology and palliative care.<\/span><\/li>\n<li><span style=\"font-weight: 400\">A new clinical domain is emerging, requiring a balance of biological validity, clinical proportionality, and existential-relational meaning.<\/span><\/li>\n<li><span style=\"font-weight: 400\">Clinicians must shift their focus from merely deciding whether to treat, to interpreting what the treatment means to the patient&#8217;s lived experience.<\/span><\/li>\n<\/ul>\n<p><b>Declaration of Interests:<\/b><br \/>\n<span style=\"font-weight: 400\">I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: None.<\/span><\/p>\n<p>&nbsp;<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Author: Yusuke Sugama, MD, PhD Medical Oncologist, Higashi Sapporo Hospital. ORCID iD: 0000-0003-2899-0512 The Blurring Lines of Treatment and Care Have you ever prescribed a systemic therapy for an advanced cancer patient, fully aware that the biological benefit might be marginal, yet feeling it was somehow the \u201cright\u201d thing to do? When a patient says, [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/spcare\/2026\/05\/11\/are-we-treating-cancer-or-meaning-the-rise-of-advanced-pharmacotherapy\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":525,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-2366","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/posts\/2366","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/users\/525"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/comments?post=2366"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/posts\/2366\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/media?parent=2366"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/categories?post=2366"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/spcare\/wp-json\/wp\/v2\/tags?post=2366"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}