Chemotherapy Near the End of Life

August 6, 2015

Chemotherapy Near the End of Life

  1. Allan S. Brett, MD

Another study calls into question this common practice.

  1. Allan S. Brett, MD

A growing body of medical literature is addressing — and often questioning — the widespread use of chemotherapy near the end of life in cancer patients with poor prognoses. In this multicenter U.S. study, researchers followed 312 patients with metastatic cancer whose disease had been refractory to at least one chemotherapy regimen and whose life expectancy was estimated to be <6 months. Lung, gastrointestinal, breast, and pancreatic cancers comprised about 70% of cases. Shortly after patients died, their closest caregivers were interviewed and were asked to rate the patients' physical distress, psychological distress, and overall quality of life during the week before death.

Half the patients were receiving chemotherapy at enrollment, and half were not. In analyses adjusted for baseline performance status, chemotherapy use at enrollment was not associated with longer survival (median survival, 4 months). Among patients with good performance status at baseline, chemotherapy use was associated with poorer quality of life near death. Among patients with moderate or poor performance status at baseline, chemotherapy use had no relation to quality of life near death.

Comment

In patients with advanced metastatic cancer who had not responded to initial chemotherapy, additional chemotherapy was not associated with prolonged survival or better quality of life near death. In fact, chemotherapy actually was associated with worse quality-of-life-near-death outcomes in patients with the best performance status at baseline. The study's obvious limitation is its observational nature. Nevertheless, editorialists — an oncologist and a palliative care specialist — believe that these findings “are generally true, represent current practice, and stand as a relative indictment of routinely offering chemotherapy to patients with terminal cancers.”

Editor Disclosures at Time of Publication

  • Disclosures for Allan S. Brett, MD at time of publication Nothing to disclose

Citation(s):

Reader Comments (6)

Bagwell MD Physician, Oncology, Clinic

And that is certainly the patient's prerogative.

Bagwell MD Physician, Oncology, Clinic

please define PFS. Thanks

Christi R.N. B.A, Other Healthcare Professional, Neurology, private duty

As a two time recipient of a Chemo regimen AND a working RN who has seen chemo in very end stage patients, I will not opt to have " hail Mary" chemo. I'm in favor of gentle medication that promotes comfort.

Camille Kilgore Other Healthcare Professional, Oncology, Research

PFS studies offer the last ounce of hope for most patients and many times succeed in extending one's life. We will always question the clinical studies offering PFS as a last resort and efficacious and adverse reaction data for end of life patients. PFS studies are many times meeting the outcomes for PFS. At what cost to each patient, nature and extent of disease and personal motivational factors do we interfere with.Unfortunately quality of life is lost at the expense of attempting all efforts for life saving measures.I have been a family member and research professional and have seen positive PFS outcomes for patients and not so in others who either do not qualify or as mentioned once first line of chemo fails, it appears patients become refractory to other measures for a host of many reasons. As a family member, you want loved ones to try and yet fear for the quality of life you give them near the end. As a research advocate, always evaluate the cost benefit ratio and continue to hope.

RAVI RAO Physician, Oncology, Pvt Practice, Fresno

This is a very relevant observation, but is often difficult to convince a patient who wants to 'do everything'. I have found that on occasion, a patient whom I tell to stop therapy switches to other providers to then give them such tx.

Jocelyne Maucotel Physician, Anesthesiology, CHUM

There is a lot of medication of all sort in the end of life not only in cancer patients bu also in late dementia patients .....

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