REVIEW ARTICLE Decision making and quality of life in the treatment of cancer: a review S. Yousuf Zafar & Stewart C. Alexander & Kevin P. Weinfurt & Kevin A. Schulman & Amy P. Abernethy Received: 16 March 2008 / Accepted: 4 September 2008 / Published online: 19 September 2008 # Springer-Verlag 2008 Abstract Introduction Complexity in decision making for cancer treatment arises from many factors. When considering how to treat patients, physicians prioritize factors such as stage of disease, patient age, and comorbid illnesses. However, physicians must balance these priorities with the patient’ s preferences, quality of life, social responsibilities, and fear of uncertainty. Although these factors are important, physicians are often unable to effectively judge their patients’ prefer- ences. Patients are often unable to fully understand their prognoses and the treatment intent. Discussion These differences influence how patients and physicians make treatment-related decisions. Partially due to these differences, patients are initially more likely than their physicians to accept greater risk for lesser benefit from treatment. As time progresses and as they experience treatment, a patient’ s preference changes, yet little is known about this process since few studies have examined it in a prospective longitudinal manner. We present an overview of the literature related to patient and physician decision making and quality of life in patients with advanced cancer, and we propose approaches to future decision-making models in cancer treatment. Keywords Decision making . Quality of life . Patient-reported outcomes Introduction Complexity in decision making for cancer treatment arises from many factors. Various treatment options often exist; both oncologists and patients must carefully weigh the risk of treatment-related toxicity versus the potential for benefit as measured by improvement in symptoms, prolonged survival, or disease control. The delicate balance between toxicity and benefit is influenced by other issues permeating the patient’ s life, including work responsibilities, family commitments, and financial burdens, with additional inputs from culture, social norms, and spirituality [29, 38, 49, 59]. Despite a large body of literature devoted to better understanding the decision-making process in cancer treat- ment, discrepancies still exist between patients, physicians, and their respective priorities. Knowing that multiple factors Support Care Cancer (2009) 17:117–127 DOI 10.1007/s00520-008-0505-2 DO00505; No of Pages S. Y. Zafar (*) Division of Medical Oncology, Department of Medicine, Duke University Medical Center, 2424 Erwin Rd, Suite G05, Hock Plaza, DUMC Box 2732, Durham, NC 27710, USA e-mail: yousuf.zafar@duke.edu S. C. Alexander Center for Palliative Care, Duke University Medical Center, Hock Plaza, 2424 Erwin Road, Suite 1105, P.O. Box 2720, Durham, NC 27705-3860, USA e-mail: stewart.alexander@duke.edu K. P. Weinfurt : K. A. Schulman Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Duke University Medical Center, P.O. Box 17969, Durham, NC 27715, USA K. P. Weinfurt e-mail: kevin.weinfurt@duke.edu K. A. Schulman e-mail: kevin.schulman@duke.edu A. P. Abernethy Division of Medical Oncology, Department of Medicine, Duke University Medical Center, 25165 Morris Building, P.O. Box 3436, Durham, NC 27710, USA e-mail: amy.abernethy@duke.edu