Late stage cancer: is additional chemotherapy advisable?

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nurse-1-1158314-mOne of the most difficult decisions a patient with late stage cancer has to make is whether or not to continue or use additional chemotherapy. Of course such decisions will be made with the input of the patient s oncologist and perhaps family members, but the final decision will be the patient s. How is one to make such a determination? How is the physician supposed to advise?

Current guidelines suggest that stronger patients who can handle their daily needs are candidates for additional or continuing chemotherapy. However, a recent study indicates that, even for these patients, the additional chemotherapy does not really benefit the patient with end-stage cancer. And an article in the New York Times reviews the current guidelines and the relevant issues that direct such decisions.

Dr. Holly G. Prigerson from the Weill Cornell Medical College and colleagues examined the effect of chemotherapy use on the quality of life for patients in their last week of life. Approximately 660 patients participated in the study, over half of whom died during the study observation period. Around 2.5 weeks after the patient s death, the most knowledgeable caregiver was interviewed and queried as to the patient s psychological and physical distress, as well as overall quality of life during the final week.

The researchers found that chemotherapy was indeed used more often in patients with a good compared with poor performance status, as measured by the Eastern Cooperative Oncology Group Performance Status (ECOG). In those patients with moderate or poor status, chemotherapy use was not associated with an improved quality of life near death. And for patients who had good ECOG scores, use of chemotherapy was actually associated with a worse quality of life near death.

The investigators concluded, Results of this study suggest that chemotherapy use among patients with chemotherapy-refractory metastatic cancer is of questionable benefit to patients QOL in their final week. Not only did chemotherapy not benefit patients regardless of performance status, it appeared most harmful to those patients with good performance status.

ACSH s Senior Nutrition Fellow Dr. Ruth Kava added, This is important information for patients, their families and physicians to understand when making the decision about whether to use chemotherapy at the end of life. If independent studies also find similar results, it would seem important for guidelines to be revised to reflect this new information.