# What does “urgency” mean when prioritizing cancer treatment? Results from a qualitative study with German oncologists and other experts during the COVID-19 pandemic

## TL;DR

This study explores how German oncologists and experts define and use 'urgency' to prioritize cancer treatments during the pandemic, revealing three key dimensions of the concept.

## Contribution

The paper introduces a nuanced framework for understanding 'urgency' in cancer care prioritization, distinguishing three dimensions and their modulating factors.

## Key findings

- 'Urgency' is seen as the most acceptable criterion for prioritizing cancer care.
- Urgency includes preventing imminent harm, future harm, and alleviating suffering.
- Success and likelihood of success further modulate the urgency of treatment.

## Abstract

Cancer care in Germany during the COVID-19 pandemic was affected by resource scarcity and the necessity to prioritize medical measures. This study explores ethical criteria for prioritization and their application in cancer practices from the perspective of German oncologists and other experts.

We conducted fourteen semi-structured interviews with German oncologists between February and July 2021 and fed findings of interviews and additional data on prioritizing cancer care into four structured group discussions, in January and February 2022, with 22 experts from medicine, nursing, law, ethics, health services research and health insurance. Interviews and group discussions were digitally recorded, transcribed verbatim and analyzed using qualitative content analysis.

Narratives of the participants focus on “urgency” as most acceptable criterion for prioritization in cancer care. Patients who are considered curable and those with a high level of suffering, were given a high degree of “urgency.” However, further analysis indicates that the “urgency” criterion needs to be further distinguished according to at least three different dimensions: “urgency” to (1) prevent imminent harm to life, (2) prevent future harm to life and (3) alleviate suffering. In addition, “urgency” is modulated by the “success,” which can be reached by means of an intervention, and the “likelihood” of reaching that success.

Our analysis indicates that while “urgency” is a well-established criterion, its operationalization in the context of oncology is challenging. We argue that combined conceptual and clinical analyses are necessary for a sound application of the “urgency” criterion to prioritization in cancer care.

The online version contains supplementary material available at 10.1007/s00432-024-05863-7.