Cancer Care at the End of Life: Balancing Disease-Directed Treatment, Palliative Care, and Symptom-Oriented Approaches

Dear Colleagues,

Patients with advanced and end-stage cancer frequently experience complex and burdensome clinical trajectories marked by high symptom load, repeated hospitalizations and escalating medical interventions. In many healthcare systems worldwide, technological advances in oncology and intensive care medicine have expanded therapeutic options, yet they have also contributed to an increasing risk of overtreatment near the end of life. Continued systemic anticancer therapies, late-line treatments and intensive care unit admissions are often administered despite limited prognostic benefit. Globally, aging populations and rising cancer incidence further intensify the challenge of aligning medical interventions with patients’ goals, quality of life and dignity in dying.

These developments highlight a pressing need to critically examine the balance between life-prolonging strategies and comfort-focused care. While innovations in oncology offer meaningful benefits earlier in the disease trajectory, their role in the final phase of life remains ethically and clinically complex. Integrating palliative care principles, improving prognostic awareness and fostering shared decision-making are increasingly recognized as essential strategies to reduce non-beneficial interventions and promote patient-centered outcomes. Addressing these issues is both timely and significant for academia and clinical practice, as healthcare systems strive to ensure high-quality, value-based and compassionate end-of-life care.

This Special Issue aims to present and disseminate the most recent advances related to the care of patients with advanced and end-stage malignancies, with a particular focus on the role and consequences of overtreatment at the end of life. We consider contributions addressing clinical, ethical, communicative and health system–related dimensions of treatment decision-making in this vulnerable population.

Topics of interest for publication include, but are not limited to, the following:

• Appropriateness and outcomes of systemic anticancer therapies near the end of life
• Decision-making regarding intensive care unit admission and life-sustaining treatments in advanced cancer
• Prognostic uncertainty and its impact on therapeutic strategies
• Symptom burden, quality of life and patient- and family-centered outcomes
• Integration of palliative care and oncology across the disease trajectory
• Interdisciplinary collaboration between oncology, palliative care and intensive care medicine

By bringing together perspectives from oncology, palliative care, intensive care and health services research, this Special Issue seeks to provide evidence-based guidance to reduce non-beneficial interventions, improve symptom management and promote comfort-focused, patient-centered care for individuals with advanced and end-stage cancer.

Dr. Gudrun Kreye
Dr. Josef Singer
Guest Editors

Dr. Nguyen-Son Le
Guest Editor Assistant

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the Special Issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2200 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.