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Outcomes of Terminally Ill Cancer Patients Receiving Palliative Chemotherapy

March 13, 2014

Outcomes of Terminally Ill Cancer Patients Receiving Palliative Chemotherapy

  1. Paul S. Mueller, MD, MPH, FACP

Chemotherapy during the last months of life was associated with elevated risk for dying in an intensive care unit.

  1. Paul S. Mueller, MD, MPH, FACP

Many patients with incurable cancers receive chemotherapy within 30 days of their deaths, but whether this practice helps or harms patients is unclear. In this analysis, U.S. investigators examined whether receiving chemotherapy during the last months of life was associated with subsequent intensive care and place of death among 386 terminally ill adults whose cancers were refractory to at least one chemotherapy regimen and who died a median 4 months after study enrollment. More than half the patients were receiving palliative chemotherapy at enrollment.

Patients who received palliative chemotherapy were significantly more likely than those who did not to prefer receiving “life-extending” over “comfort” care (39% vs. 26%); likewise, they were more likely to express a preference for receiving chemotherapy if it might extend life by 1 week (86% vs. 60%). Palliative chemotherapy patients also were significantly more likely to receive cardiopulmonary resuscitation or mechanical ventilation or both during the last week of life (14% vs. 2%), feeding tubes during the last week of life (11% vs. 5%), and late hospice referral (≤1week; 54% vs. 37%); in addition, they were more likely to die in an intensive care unit (11% vs. 2%) and less likely to die at home (47% vs. 66%). However, survival duration did not differ between the groups.

Comment

In this study, terminally ill patients receiving palliative chemotherapy were more likely to undergo invasive treatments — but did not survive longer — than patients not receiving palliative chemotherapy. As the authors point out, in 2012, the American Society for Clinical Oncology identified end-of-life chemotherapy as a practice to be avoided.

  • Disclosures for Paul S. Mueller, MD, MPH, FACP at time of publication Consultant / advisory board Boston Scientific (Patient Safety Advisory Board) Leadership positions in professional societies American Osler Society (Secretary)

Citation(s):

Reader Comments (3)

CA Hill, RNC, BA Other Healthcare Professional, Geriatrics, Retired

People very often are unwilling/unable to accept the inevitability of death. As a Registered Nurse, I have seen the desperation with which they cling to "life." And I know that their physicians have carefully explained the pros and cons of additional treatment. to them. Sometimes the family can ease the process by giving permission to stop fighting death.

Avis Halberstadt Other, Other, Retired

As a stage 4 metastatic breast cancer patient of 16 years, I have made the decision not to have chemotherapy as my treatment of choice. I have been treated with hormone therapy for many years. When that no longer works, I will receive palliative care without any treatment other than medicine for pain. For me, quality of life is much more important than surviving without hope of improvement. I believe this will benefit everyone involved in my care.

Brian Mahood Physician, Pulmonary Medicine, Waikato Hospital, Hamilton, NZ (retired)

I am fully aware that people receiving palliative care are still hoping that they will 'beat their underlying illness' but it surprises me that they and their family have not been advised by their practitioners about the likelihood of success, or the lack of it in their situation. Surely discussions will have been undertaken to clarify things with them.

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