One question asked whether the respondent would be willing to have life prolonged for three months by receiving intensive or mild treatment. More patients expressed a willingness to take either treatment compared with controls (42% vs 10% and 53% vs 25%, respectively). Doctors and nurses showed significantly less likelihood to accept therapy under these conditions (p<0.001).

The survey of Bremnes found patients and surgical nurses most reluctant to demand or accept toxic therapy providing minimal or no benefit (Eur J Cancer 1995;31A:1955-1959). Cancer patients under 50 years were significantly more willing to accept the regimen than the controls, oncologists, surgeons, oncology nurses, or surgical nurses.

One of the seven queries asked "Would you tell this patient that he/she has cancer, if he/she asks no questions?" Of the 252 responses, there were 104 yes and 148 no. Most northern Europe gastroenterologists would tell the patient while southern and eastern Europe specialists would not.

Another question asked: "Would you tell the patient that the condition is incurable?" In this instance, 207/253 (82%) answered negatively. Most European gastroenterologists, except those in northern countries, would not tell the patient. If told, the doctor tended to embellish the message. In contrast, most of the surveyed gastroenterologists would tell the spouse the full truth about the diagnosis and prognosis.

• Patients have a fundamental right to participate in decisions about their therapy.
• Caregivers cannot make assumptions on patient attitudes and values which often differ.
• Decision-making, especially in advanced cancer, needs to be shared with the patient.

The impact of cancer and chemotherapy on the patient could be lessened by improved sensitivity to patient-centered factors.