Researchers believe end-of-life chemotherapy does more harm than good for most cancer patients.
Recent findings are challenging the common clinical practice and accepted treatment guidelines that cancer patients should undergo chemotherapy in the final weeks of their lives, Cornell University reported. The study is calling for clinicians to re-evaluate the common use of chemotherapy in these cases.
The study found the majority of patients who had six months or less to live and received palliative chemotherapy did not see a reduction in symptoms or an extended survival rate. In fact, palliative chemotherapy was associated with a reduced quality of life in patients who were otherwise healthy and active at the start of the study. Patients who were less healthy at the study's outset generally saw no effect from the treatment one way or the other. Under current guidelines, patients who are bedridden for more than 50 percent of the time or have lost the ability to care for themselves are advised to avoid chemotherapy, but healthier patients are usually urged to undergo the treatments.
"This study demonstrates that palliative chemotherapy does not appear to palliate symptoms even in the most robust patients who can tolerate chemotherapy," Prigerson said. "It raises questions about the rationale for such aggressive, burdensome care."
To make their findings, the researchers looked at 661 end-stage patients with advanced metastatic disease and cancer progression following prior chemotherapy regimens. Approximately four months before death, investigators used a scale called the Eastern Cooperative Oncology Group (ECOG) Performance Status to determine the patients' well-being. Interviews were conducted after death to determine levels of psychological and physical distress and overall quality of life in the week before death.
The findings showed all of the patients with an ECOG score of zero (fully active and with symptoms) were receiving chemotherapy at the beginning of the study. Patients with ECOG scores of zero or one (ambulatory and able to carry out light work) who were receiving chemotherapy at the beginning of the study had significantly lower quality of life at the end of their lives than those who were not receiving chemotherapy. Only 45 percent of patients with an ECOG score of one whore received chemotherapy had high ECOG scores in the last week of their lives, compared to 70 percent of those not receiving the treatment.
"Although we did not find a survival advantage associated with use of chemotherapy, this study was not designed to examine survival. We have proposed further research to examine this explicitly," Prigerson said. "Nevertheless, these data show that incurable cancer patients with a limited life expectancy who use chemotherapy are likely to impair the quality of their remaining days. Oncologists may presume there to be no harm in giving dying patients chemotherapy, but these data point to more harm than benefit."
The findings were published in a recent edition of the journal JAMA Oncology.
