Palliative Chemotherapy may have Unintended End of Life Consequences

The impact of palliative chemotherapy on end of life care is examined

  • Date: 05 Mar 2014
  • Author: Lynda Williams, Senior medwireNews Reporter
  • Topic: Palliative Care

medwireNews: Palliative chemotherapy for terminally ill cancer patients may not always help patients to achieve the end of life experiences they would prefer, US researchers caution.

The study of 386 patients with chemotherapy-refractory metastatic disease showed that patients given palliative chemotherapy were more likely to require intensive medical care in their last week of life than patients who did not receive further chemotherapy.

Cardiopulmonary resuscitation and/or mechanical ventilation were given to 14% of the 216 patients enrolled in palliative chemotherapy compared with just 2% of those who were not, with feeding tubes used by 11% and 5%, respectively.

Palliative chemotherapy was also associated with a higher rate of late referrals for hospice care (54 vs 37%), as well as with patients being less likely to die in their preferred place of death (68 vs 80%) and more likely to die in an intensive care unit (11 vs 2%), report Holly Prigerson, from Weill Cornell Medical College in New York, and colleagues.

Of concern, patients receiving palliative chemotherapy were less likely to acknowledge their illness as terminal than those who were not (35 vs 49%) and to have discussed their end of life wishes with a physician (37 vs 48%).

Palliative chemotherapy recipients were also more likely than non-recipients to express a preference for life-extending care over comfort care (39 vs 26%), especially if treatment would extend their life by 1 week (86 vs 60%).

But the study, published in the BMJ, did not find a significant difference in overall survival between the patient groups.

Holly Prigerson and co-authors emphasise that the study was not powered to show that palliative chemotherapy is “futile."

Instead, the team suggests that the findings “should serve as a reminder that palliative chemotherapy does not necessarily extend life, but is associated with more intensive end of life care and increased risk of dying in an intensive care unit, so continuing treatment should not come at the cost of engaging in advance care planning.”

In an accompanying editorial, Michael Rabow, from the University of California at San Francisco, USA, comments that the choice to begin chemotherapy should not be the end of decision-making, noting that patients in the USA often have to choose between treatment or hospice care.

“Especially perhaps near the end of life, the choice to accept chemotherapy should not lead oncologists and patients to abandon key care assessments and planning, including regular evaluation of the efficacy of chemotherapy, advance care planning, exploration of the benefits of hospice care, and pursuit of one’s preferred place of death.”

References

Wright A, Zhang B, Keating N, et al. Associations between palliative chemotherapy and adult cancer patients’ end of life care and place of death: prospective cohort study. BMJ 2014; 348:  Published 4 March. doi: http://dx.doi.org/10.1136/bmj.g1219

Rabow M. Chemotherapy near the end of life. BMJ 2014; 348: Published 4 March. doi: http://dx.doi.org/10.1136/bmj.g1529

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