{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:34:45Z","timestamp":1782488085555,"version":"3.54.5"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:00:00Z","timestamp":1751932800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005972","name":"Deutsche Krebshilfe","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005972","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Being diagnosed with cancer is a life-altering event that profoundly reshapes an indivdual\u2019s biography, especially in terms of temporality and physicality. Modern treatment approaches, such as maintenance therapy or therapeutic abstinence, often conflict with patients\u2019 desire for a radical fight against the disease. Decision-making about therapeutic goals is shaped by the tension between medical-scientific expertise and personal values and experiences, making it particularly challenging to align diverse preferences and norms. This study aims to analyse values in the context of the challenging human experience of cancer. We hypothesise that conventional quantitative measures, including patient-reported outcome measures (PROMs) may be insufficient to fully capture patients\u2019 perspective on therapeutic success. To address this, we will conduct semi-structured interviews with individuals diagnosed with gynecological or colorectal cancer. Using a mixed methods approach, we aim to identify patients\u2019 values, treatment goals, and expectations. The study\u2019s key outcomes include: 1) an ethical analysis of values in the context of cancer experiences 2) a reconstruction of values that shape individual treatment goals and expectations and 3) a comparison between ethical concepts of successful life, patients\u2019 situational values, and evidence-based medical preferences. Building on these insights, the study pursues three secondary objectives: 1) developing a strategy for patient-centred adaptation of clinical evaluations of treatment approaches, including escalation, maintenance and abstinence, 2) designing a well-defined clinical framework for therapeutic goal setting, and 3) integrating this framework into medical education, addressing clinical, oncological, ethical and communication competencies.<\/jats:p>","DOI":"10.3389\/fonc.2025.1588721","type":"journal-article","created":{"date-parts":[[2025,7,8]],"date-time":"2025-07-08T00:10:30Z","timestamp":1751933430000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Escalation, maintenance and abstention in oncology a new study design to identify how individual values of patients impact on the assessment of risks and benefits of novel therapeutic concepts in cases of gynaecological tumors and colorectal cancer: a study protocol"],"prefix":"10.3389","volume":"15","author":[{"given":"Susanne","family":"Theis","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00fclide","family":"Senyigit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Britta","family":"B\u00fcchler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gesa","family":"Kolck","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus","family":"Moehler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette","family":"Hasenburg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Norbert","family":"Paul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,8]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s00761-010-1889-4","article-title":"Ethics in oncology","volume":"16","author":"Adamietz","year":"2010","journal-title":"Der Onkol"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1007\/s00761-002-0465-y","article-title":"Ethische brennpunkte in der onkologie","volume":"9","author":"Weiss","year":"2003","journal-title":"Der Onkol"},{"key":"B3","article-title":"Berry Adaptive Clinical Trials: The Promise and the Caution","volume-title":"JCO","author":"Donald","year":"2011"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1007\/s00432-014-1829-6","article-title":"Inclusion of targeted therapies in the standard of care for metastatic colorectal cancer patients in a German cancer center: the more the better","volume":"141","author":"Lang","year":"2015","journal-title":"J Cancer Res Clin Oncol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"799","DOI":"10.1097\/SLA.0000000000003527","article-title":"Extended molecular profiling improves stratification and prediction of survival after resection of colorectal liver metastases","volume":"270","author":"Lang","year":"2019","journal-title":"Ann Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"JCO.19.01340","DOI":"10.1200\/JCO.19.01340","article-title":"FOLFOXIRI plus panitumumab as first-line treatment of RAS wild-type metastatic colorectal cancer: The randomized, open-label, phase II Volfi study (AIO KRK0109)","volume":"37","author":"Modest","year":"2019","journal-title":"J Clin Oncol"},{"key":"B7","first-page":"21","article-title":"Erhaltungstherapie bei indolenten Lymphomen","volume-title":"Im Focus Onkologie","author":"von Kieseritzky","year":"2016"},{"key":"B8","article-title":"S3-Leitlinie \u201cDiagnostik, Therapie und Nachsorge Maligner Ovarialtumoren","volume-title":"Forum","author":"Wagner","year":"2019"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2017.5314","article-title":"Activity and safety of cetuximab plus modified FOLFOXIRI followed by maintenance with cetuximab or bevacizumab for RAS and BRAF wild-type metastatic colorectal cancer: a randomized phase 2 clinical trial","volume":"4","author":"Cremolini","year":"2018","journal-title":"JAMA Oncol"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1002\/ijc.32110","article-title":"Panitumumab-based maintenance after oxaliplatin discontinuation in metastatic colorectal cancer: A retrospective analysis of two randomised trials","volume":"145","author":"Modest","year":"2019","journal-title":"Int J Cancer"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.5070","article-title":"Cost-effectiveness of maintenance capecitabine and bevacizumab for metastatic colorectal cancer","volume":"5","author":"Sherman","year":"2019","journal-title":"JAMA Oncol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/j.critrevonc.2017.02.025","article-title":"Role of hypoxia-inducible factors (HIF) in the maintenance of stemness and Malignancy of colorectal cancer","volume":"113","author":"Vadde","year":"2017","journal-title":"Crit Rev Oncol\/hematol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1126\/science.aav4474","article-title":"Adaptive mutability of colorectal cancers in response to targeted therapies","volume":"366","author":"Russo","year":"2019","journal-title":"Science"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1908075","article-title":"Encorafenib, binimetinib, and cetuximab in BRAF V600E\u2013mutated colorectal cancer","volume":"381","author":"Kopetz","year":"2019","journal-title":"New Engl J Med"},{"key":"B15","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1200\/JCO.19.02107","article-title":"Phase II open-label study of pembrolizumab in treatment-refractory, microsatellite instability\u2013high\/mismatch repair\u2013deficient metastatic colorectal cancer: KEYNOTE-164","volume":"38","author":"Le","year":"2020","journal-title":"J Clin Oncol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1016\/j.critrevonc.2018.07.001","article-title":"Immuno-oncology in GI tumours: Clinical evidence and emerging trials of PD-1\/PD-L1 antagonists","volume":"130","author":"Stein","year":"2018","journal-title":"Crit Rev Oncol\/hematol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdz387","article-title":"Consensus molecular subgroups (CMS) of colorectal cancer (CRC) and first-line efficacy of FOLFIRI plus cetuximab or bevacizumab in the FIRE3 (AIO KRK-0306) trial","volume":"30","author":"Stintzing","year":"2019","journal-title":"Ann Oncol"},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1055\/s-00000097","article-title":"Der Krebs als Brennglas des Lebens\u2013F\u00fcr eine Ethik der Zuwendung in der Onkologie","volume":"48","author":"Maio","year":"2016","journal-title":"Deutsche Z F\u00fcr Onkol"},{"key":"B19","article-title":"W\u00fcnsche, Werte und Moral: Entwurf eines handlungstheoretischen und ethischen Internalismus in Existenz und Wissenschaft, Hrsg","author":"Sch\u00e4like","year":"2002"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1007\/s00112-016-0106-y","article-title":"\u00dcberbringen schlechter Nachrichten in der P\u00e4diatrie: Das Gewicht der Worte","volume":"7","author":"Paul","year":"2016","journal-title":"Monatsschrift Kinderheilkunde"},{"key":"B21","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-540-75820-4_19","article-title":"Klinische Ethikberatung: Therapieziele, Patientenwille und Entscheidungsprobleme in der modernen Medizin","volume-title":"Grenzsituationen in der Intensivmedizin","author":"Paul","year":"2008"},{"key":"B22","article-title":"Geschichte, Theorie und Ethik der Medizin \u2013 Eine Einf\u00fchrung, Frankfurt a. M.: Suhrkamp","author":"Schulz","year":"2006"},{"key":"B23","first-page":"5242","article-title":"Philosophische Handlungstheorie","author":"Quante","year":"2020"},{"key":"B24","unstructured":"Brustkrebs (Mammakarzinom) ICD-10 C50. Krebsarten 2022\n          \n          \n            \n              Zentrum f\u00fcr Krebsregisterdaten\n              RKI\n            \n          \n          \n          2025"},{"key":"B25","unstructured":"Geb\u00e4rmutterhalskrebs (Zervixkarzinom) ICD-10 C53. Krebsarten 2022\n          \n          \n            \n              Zentrum f\u00fcr Krebsregisterdaten\n              RKI\n            \n          \n          \n          2025"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.1007\/s00761-018-0507-8","article-title":"Epidemiologie von eierstockkrebs in deutschland","volume":"25","author":"Buttmann-Schweiger","year":"2019","journal-title":"Der Onkol"},{"key":"B27","volume-title":"Was ist Darmkrebs und wie h\u00e4ufig tritt er auf? Krebsarten 2025","year":"2019"},{"key":"B28","volume-title":"Constructing grounded theory: A practical guide through qualitative analysis","author":"Charmaz","year":"2006"},{"key":"B29","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-658-13213-2_59","article-title":"Barney G. Glaser\/Anselm L. Strauss: the discovery of grounded theory. Strategies for qualitative research, aldine publishing company: Chicago 1967, 271 S. (dt. Grounded theory. Strategien qualitativer forschung, bern: huber 1998, 270 S.)","volume-title":"Klassiker der Sozialwissenschaften: 100 Schl\u00fcsselwerke im Portrait","author":"Hunger","year":"2016"},{"key":"B30","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1177\/1525822X05279903","article-title":"How many interviews are enough?:An experiment with data saturation and variability","volume":"18","author":"Guest","year":"2006","journal-title":"Field Methods"},{"key":"B31","article-title":"Sample size and saturation in PhD studies using qualitative interviews","volume-title":"Forum qualitative Sozialforschung\/Forum: qualitative social research","author":"Mason","year":"2010"}],"container-title":["Frontiers in Oncology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1588721\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,10]],"date-time":"2025-07-10T09:44:11Z","timestamp":1752140651000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fonc.2025.1588721\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,8]]},"references-count":31,"alternative-id":["10.3389\/fonc.2025.1588721"],"URL":"https:\/\/doi.org\/10.3389\/fonc.2025.1588721","relation":{},"ISSN":["2234-943X"],"issn-type":[{"value":"2234-943X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,8]]},"article-number":"1588721"}}