Major Study Questions Aggressive Cancer Treatment

Benefit of End-Stage Chemotherapy Is Questioned

by: Pam Belluck

It is an excruciating question for cancer patients with a prognosis of only months to live. Should they try another round of chemotherapy?

Guidelines for oncologists say no for very sick patients, those who are often bedridden and cannot handle most daily needs themselves. But for patients who are more self-sufficient, chemotherapy is considered a reasonable option. Despite its well-known toxic side effects, many end-stage patients and their doctors have considered chemotherapy worth trying, believing it may ease discomfort or buy time.

Now, a study suggests that even those stronger patients may not benefit from end-of-life chemotherapy — and that for many, their quality of life may worsen in their final weeks compared with patients who forgo last-ditch treatment.

It worsened quality of life for those that are relatively healthy, and those are the ones that the guidelines support treating,” said Dr. Charles D. Blanke, a medical oncologist at Oregon Health and Science University, who was not involved in the study. “Chemotherapy is supposed to either help people live better or help them live longer, and this study showed that chemotherapy did neither.”

The study, published Thursday in JAMA Oncology, followed 312 adult patients with a prognosis of six months or less to live. The patients, in six oncology clinics across the country, all had solid-tumor cancers that had metastasized. The types included lung, colon, pancreatic and breast cancer. About half opted for end-stage chemotherapy.

After each died, researchers asked the relative or caregiver most knowledgeable about their well-being to rate the patient’s physical and psychological distress and overall quality of life in their last week of life. (The caregivers’ views were considered reliable because their assessment at the study’s outset matched the patients’ own quality-of-life assessments.)

For patients who were sicker at the start, caregiver ratings of their last week’s quality of life were similar whether they received chemotherapy or not.

But for the 122 patients with fewer initial symptoms, the results were striking. Of those receiving chemotherapy, 56 percent were reported to have lower quality of life in their last week, compared with 31 percent of those who did not have chemotherapy.

Source: New York Times

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Major Study Questions Aggressive Cancer Treatment

Benefit of End-Stage Chemotherapy Is Questioned