In an article (and podcast) in the British Medical Journal (BMJ) last November, Peter Wise, a former consultant physician, argues that the nearly 20% improvement in five year survival from cancer over the past four decades is probably mainly due to improved early diagnosis and treatment rather than developments in chemotherapy. He believes that patients are being badly misled by over-enthusiastic accounts of what chemotherapy can achieve. Many expect a cure. In reality they will gain on average only a few months of extra life.

An editorial accompanying this articles comments: ‘Unjustified enthusiasm for cancer drug treatments comes at huge cost, financial and personal (including treatment related deaths and reduced quality of life), and increased risk of dying in hospital rather than at home. Many patients don’t realise that opting for supportive rather than active treatment—often called “refusal”—is an option and may give them longer as well as better quality life than chemotherapy. Conflicts of interest among clinicians compound their reluctance to have tricky conversations.’

This editorial makes the case persuasively for advance care planning that recognises the possibility of refusing treatments that are likely to have little benefit and come at the cost of a loss of quality of the remaining life.

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