Chemotherapy QoL Caution for End-Stage Cancer Patients

Palliative chemotherapy use is of “questionable benefit” for end-stage cancer patients

medwireNews: Palliative chemotherapy in patients with end-stage cancer does not improve quality of life (QoL) for patients with intermediate or poor health performance status and may be harmful to those with a good status, US researchers say.

Follow-up of 312 patients with treatment-refractory, progressive metastatic cancer for a median of 3.8 months before their death showed that 50.6% had received at least one chemotherapy regimen in this time but receipt did not offer a significant survival benefit.

Moreover, caregiver ratings of patient physical and mental distress in their final week revealed that QoL near death (QoD) was not significantly influenced by use of chemotherapy in patients with a baseline European Cooperative Oncology Group (ECOG) score of 2 or 3, denoting moderate or poor performance status.

And for patients with a good ECOG score of 1, indicating the patient was ambulatory and able to perform light work, receipt of chemotherapy was associated with a significantly lower QoD than no chemotherapy (odds ratio=0.35).

This association remained true even after adjusting for the need for intensive care interventions in the final week of life, such as ventilation, report Holly Prigerson, from Weill Cornell Medical College in New York, and team.

Noting that American Society of Clinical Oncology guidelines recommend palliative chemotherapy be used only for end-stage cancer patients with a good performance status, the authors suggest in JAMA Oncology that this advice “may need to be revised to recognize the potential harm of chemotherapy use in patients with progressive metastatic disease.”

Charles Blanke and Erik Fromme, from Oregon Health and Science University in Portland, USA, write in an accompanying comment that it is “disconcerting” that oncologists recommend systemic palliative chemotherapy when late-line therapy is ineffective for many solid tumours.

“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 6 months, the default should be no active treatment”, they recommend.

“Oncologists with a compelling reason to offer chemotherapy in that setting should only do so after documenting a conversation discussing prognosis, goals, fears, and acceptable trade-offs with the patient and family.”

References

Prigerson HG, Bao Y, Shah MA, et al. Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol 2015; Advance online publication 23 July. doi:10.1001/jamaoncol.2015.2378

Blanke CD, Fromme EK. Chemotheray near the end of life. First – and third and fourth (line) – do no harm. JAMA Oncol 2015; Advance online publication 23 July. doi:10.1001/jamaoncol.2015.2379.

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