Patient Pragmatism

Chemotherapy for patients with end-stage cancer was associated with worse quality of life near death for patients with a good ability to still perform many life functions, according to an article published online by JAMA Oncology.

Physicians have voiced concerns about the benefits of chemotherapy for patients with cancer who are nearing death. An American Society of Clinical Oncology (ASCO) expert panel has called chemotherapy use among patients for whom there was no evidence of clinical value the most widespread, wasteful and unnecessary practice in oncology.

Holly G. Prigerson, Ph.D., of Weill Cornell Medical College, New York Presbyterian Hospital, New York and colleagues examined the association between chemotherapy use and quality of life near death as a function of patients’ performance status, which ranks their ability to perform activities such as be ambulatory, do work and handle self-care.

Study results showed that chemotherapy was not associated with improved quality of life near death for patients with moderate or poor ability to perform functions. But chemotherapy was associated with worse quality of life near death compared with non-use of chemotherapy for patients with a good ability to still perform life functions.

“Not only did chemotherapy not benefit patients regardless of performance status, it appeared most harmful to those patients with good performance status. ASCO guidelines regarding chemotherapy use in patients with terminal cancer may need to be revised to recognise the potential harm of chemotherapy use in patients with progressive metastatic disease,” the study concludes.

In a related commentary, Charles D. Blanke, M.D., and Erik. K. Fromme, M.D., of the Oregon Health & Science University, Portland write: “These data from Prigerson and associates suggest that equating treatment with hope is inappropriate. Even when oncologists communicate clearly about prognosis and are honest about the limitations of treatment, many patients feel immense pressure to continue treatment. … At this time, it would not be fitting to suggest guidelines must be changed to prohibit chemotherapy for all patients near death without irrefutable data defining who might actually benefit, but if an oncologist suspects the death of a patient in the next six months, the default should be no active treatment,” the author concludes.


 

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