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A growing body of medical literature is addressing — and often questioning — the widespread use of chemotherapy near the end of life in cancer patients with poor prognoses. In this multicenter U.S. study, researchers followed 312 patients with metastatic cancer whose disease had been refractory to at least one chemotherapy regimen and whose life expectancy was estimated to be <6 months. Lung, gastrointestinal, breast, and pancreatic cancers comprised about 70% of cases. Shortly after patients died, their closest caregivers were interviewed and were asked to rate the patients' physical distress, psychological distress, and overall quality of life during the week before death.
Half the patients were receiving chemotherapy at enrollment, and half were not. In analyses adjusted for baseline performance status, chemotherapy use at enrollment was not associated with longer survival (median survival, 4 months). Among patients with good performance status at baseline, chemotherapy use was associated with poorer quality of life near death. Among patients with moderate or poor performance status at baseline, chemotherapy use had no relation to quality of life near death.
Prigerson HG et al. Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol 2015 Jul 23; [e-pub]. (http://dx.doi.org/10.1001/jamaoncol.2015.2378)
Blanke CD and Fromme EK.Chemotherapy near the end of life: First —and third and fourth (line) — do no harm. JAMA Oncol 2015 Jul 23; [e-pub]. (http://dx.doi.org/10.1001/jamaoncol.2015.2379)
Comment
In patients with advanced metastatic cancer who had not responded to initial chemotherapy, additional chemotherapy was not associated with prolonged survival or better quality of life near death. In fact, chemotherapy actually was associated with worse quality-of-life-near-death outcomes in patients with the best performance status at baseline. The study's obvious limitation is its observational nature. Nevertheless, editorialists — an oncologist and a palliative care specialist — believe that these findings “are generally true, represent current practice, and stand as a relative indictment of routinely offering chemotherapy to patients with terminal cancers.”