Physicians have voiced concerns about the benefits of chemotherapy for patients with cancer who are nearing death. (The caregivers’ views were considered reliable because their assessment at the study’s outset matched the patients’ own quality-of-life assessments.). “Even when oncologists communicate clearly about prognosis and are honest about the limitations of treatment, many patients feel enormous pressure to continue treatment”, the editorial said.
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The study was published online July 23 in the journal JAMA Oncology.
The research has been conducted with the help of the patients’ relatives, who have provided details in relation to the health condition of the patients when they were no longer capable of responding to questionnaires.
Among the patients who at the start of the study were generally healthiest and most active, palliative chemotherapy use was associated with worse quality of life in their last week of life and showed no benefit to overall survival.
“Patients with end-stage cancer are encouraged by friends and family to keep fighting, but the battle analogy itself can portray the dying patient as a loser and should be discouraged”, Blank and Fromme wrote.
For patients who were more sickly at the start, the caregiver rating of their last week’s quality of life was essentially the same whether they received chemotherapy or not.
Researchers examined the effect of chemotherapy on patient quality of life in the last week of life as a function of patients’ performance status, which ranks their ability to perform activities such as be ambulatory, do work and handle self-care.
The two main reasons for patients with metastatic cancer to undergo chemotherapy are to live longer and to live better. In fact, for people who could still work and perform day-to-day tasks, chemotherapy was associated with a worsened quality of life, the study found. Among those who were not receiving chemotherapy, 70 percent had a high quality of life score.
Holly G. Prigerson, a director of the Center for Research on End-of-Life Care at Weill Cornell Medical College and the study’s principal investigator, said she and colleagues had expected “the exact opposite”.
When patients don’t talk about the end of life, Smith said, “you lose so many opportunities for a family to say, ‘My time is limited”. The chemotherapy administered at this stage was palliative, and the study did not find any difference in survival.
Researchers believe end-of-life chemotherapy does more harm than good for most cancer patients. About half of the patients were receiving what’s known as palliative chemotherapy when the study began. “So, we wanted to look at whether patients who were getting palliative chemotherapy had better of worse quality of life”.
“The real kicker is it’s the people who are performing well, who are thinking they’re going to benefit, that didn’t”, she said. “If you give Superman Kryptonite, his super powers will go away and if you give a person something poisonous, they’re not going to be feeling better”, Prigerson said.
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The article also pointed out that a 2012 expert panel to the American Society of Clinical Oncology (ASCO) had “described chemotherapy use among patients for whom there was no evidence of clinical value as the most widespread, wasteful, and unnecessary practice in oncology”. Prigerson hopes the new study will help raise the question of whether that is appropriate, since it may make patients feel worse.
