The recommendation to use palliative chemotherapy (PC) in patients (pts) with advanced cancer and poor performance status (ECOG-PS) is controversial and could be harmful. However, in routine practice some oncologists still recommend it. We sought to identify the outcomes and related prognostic factors of PC in these pts treated in a large academic cancer center.
We retrospectively reviewed all consecutive pts with poor ECOG-PS metastatic solid tumors who received PC during hospitalization for symptom control from January 2015 to September 2017. Eligible pts had ECOG-PS 3/4 and started first line PC or had ECOG-PS ≥2 and started second or further lines. Pts with known chemo-sensible tumors (germ cell, ovary, small cell lung cancer) and primary central nervous system were excluded. The primary end point was survival rate within 30 days from the date of first cycle. Logistic regression was used to identify prognostic factors associated with this mortality rate.
We identified 228 consecutive pts. The median age was 56 years old, 133 pts (58%) were female, 150 pts (66%) were chemotherapy-naïve and almost half of pts had primary gastrointestinal tumors. 21.9%, 66.7% and 11.4% pts had ECOG-PS 2, 3 and 4, respectively. With a median follow-up of 49 days, 224 pts (98.2%) died. Nearly two thirds (N = 142) of pts died while hospitalized, with 31 (13.8%) dying while in ICU, 27 pts (12%) died in a hospice and 2 pts passed away at home. The median overall survival was 38.5 days and the survival rates within 30 and 60 days of chemotherapy were 55.7% and 38.5%, respectively. In the multivariate analysis, ECOG-PS 3/4 (OR 2.45; p = 0.015) and baseline values of anemia (OR 0.41; p = 0.034), hypercalcemia (OR 2.71; p = 0.410) and elevated total bilirubin level (5.14; p < 0.001) were significantly associated with 30-day mortality.
Most pts with advanced cancer and poor performance status clearly do not benefit from PC, especially those with ECOG-PS 3/4, hypercalcemia and elevated bilirubin. Transparent conversation with pts and their families about prognosis and the inefficiency of PC in this setting is crucial to avoid futile interventions.
Clinical trial identification
Legal entity responsible for the study
Comitê de Ética e Pesquisa ICESP - Instituto do Câncer do Estado de São Paulo.
Has not received any funding.
All authors have declared no conflicts of interest.