Researchers find no benefit from chemotherapy at end of life

Chemotherapy near death failed to improve quality of life (QOL) for patients with cancer, even those who otherwise were in good health, a review of end-of-life care showed.

Quality of life near death (QOD) deteriorated in patients who had good performance status when they started chemotherapy. Palliative chemotherapy had no impact on QOL among sicker patients, Holly Prigerson, PhD,…and colleagues reported online in JAMA Oncology.

…”Thus, chemotherapy appears to contribute directly to worse QOD, presumably through adverse and toxic effects that impair the QOL of those who are initially feelling well.”

Organizations that have clinical guidelines addressing end-of-life chemotherapy, such as the American Society of Clinical Oncology (ASCO), might need to rethink their recommendations, Prigerson and colleagues added.

Even an accompanying editorial expressing some disagreement…acknowledged that “if an oncologist suspects the death of a patient in the next 6 months, the default should be no active treatment.”…

Three years ago, ASCO’s expert panel for the “Choosing Wisely” campaign identified use of chemotherapy in patients for whom no proven benefit existed as one of the most widespread, wasteful, and unnecessary practices in oncology. ASCO recommends against the use of chemotherapy for patients who have not benefited from prior therapy…

Prigerson and colleagues examined the association among ECOG performance status, chemotherapy, and QOL in the last week of life…They hypothesized that patients with good performance status would have worse QOL if they received additional chemotherapy, and that patients with poor performance status would not have an improvement in quality of life with chemotherapy…

Beyond the data, the study suggests that “equating treatment with hope is inappropriate,” Blanke and Fromme said.

“Even when oncologists communicate clearly about prognosis and are honest about the limitations of treatment, many patients feel immense pressure to continue treatment,” they said. “Patients with end-stage cancer are encouraged by friends and family to keep fighting, but the battle analogy itself can portray the dying patient as a loser and should be discouraged. Costs aside, we fell the last 6 months of life are not best spent in an oncology traetment unit or at home suffering the toxic effects of largely ineffectual therapies for the majority of patients.”

Time to turn away from the greed-centric portion of the medical-industrial complex, folks. Pay attention to the folks who say, as did these researchers, “This is a clarion call…to take the lead in curtailing the use of ineffective therapy and ensuring a focus on palliative care and relief of symptoms throughout the course of illness.

Overdue.

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