New Paradigms of Cancer Require New Language: A Qualitative Study Exploring Language for Non-Curative Non-Palliative Cancer Surgery.

Background and methodsCancer interventions are traditionally described as either "curative" or "palliative," but evolving cancer biology and new treatments have transformed some cancers into chronic diseases where surgery plays a non-curative, disease-targeted role. We conducted semi-structured interviews with cancer surgeons via purposive snowball sampling, exploring two hypothetical scenarios and discussing "disease-control" surgery as a category of neither palliative nor curative surgical intent. Interviews were thematically analyzed.ResultsEighteen surgeons from 16 US institutions described how evolving cancer treatment paradigms challenge existing language for surgical intent. "Disease-control" surgery captured new adjuvant surgical roles including debulking to improve systemic therapy efficacy, resection of treatment-resistant disease, and "resetting the clock" for indolent tumors. Surgical goals are increasingly defined by individual patients' broader multidisciplinary treatment trajectory.ConclusionsTraditional "curative" versus "palliative" categories inadequately describe contemporary cancer surgery. New frameworks aligned with current understandings of cancer biology and new treatment modalities may facilitate clearer communication about surgical goals and enable developing appropriate research outcome measures.DiscussionThese findings highlight a need for standardized surgical intent terminology. Broader validation through multidisciplinary stakeholder engagement is needed to refine and implement this proposed framework.