Chemotherapy for end-stage cancer questioned

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Giving chemotherapy to patients with end-stage progressive metastatic disease may cause more harm than good, according to a JAMA Oncology study published July 23.

Researchers evaluated the association between chemotherapy use and quality of life near death as a function of patients’ performance status. They studied a multi-institutional, longitudinal cohort of patients with end-stage cancer recruited between September 2002 and February 2008.

Three hundred and twelve patients with metastatic cancer were followed. Of the group, 158 were receiving chemotherapy and 154 were not. Performance status was assessed at baseline (a median of about four months before death). The majority of patients were men and the average age of patients was 58.6 years.

Patient QOD was determined using caregiver ratings of their patients’ physical and mental distress in their final week of life.

Results showed chemotherapy use was not associated with patient survival, controlling for clinical setting and patients’ performance status.

Researchers pointed to the concerns physicians have voiced about the benefits of chemotherapy for patients with cancer nearing death.

The American Society of Clinical Oncology expert panel identified chemotherapy use among patients for whom there was no evidence of clinical value as the most widespread, wasteful and unnecessary practice in oncology, researchers stated, which is why they focused on performance status scores in their study.

“Specifically, ASCO guidelines recommend against the use of chemotherapy in solid tumor patients who have not benefited from prior treatment and who have an Eastern Cooperative Oncology Group performance status score of 3 or more (ie, bad or more debilitated than ‘capable of only limited self-care,confined to bed or chair more than 50% of waking hours,’” they stated.

The study showed patients with good performance status were the ones most likely to receive chemotherapy near the end of life. However, patients with a low ECOG performance status (0 to 1) had significantly worse QOD than those who avoided chemotherapy. No difference in QOD scores was observed by chemotherapy use among those with ECOG scores of 2 or 3.

Researchers found no observed survival benefit in the studied patients with refractory metastatic disease and highlighted the potential harm of chemotherapy in patients toward the end of life even in patients with good performance status.

“Our study does highlight the danger of continuing chemotherapy as patients approach the end of life,” researchers wrote. “Notably, in the patients with the highest function (eg, patients most likely to be receiving chemotherapy as in our sample and as per ASCO guidelines), the QOL in the last week of life was significantly and meaningfully lower than in those not receiving chemotherapy at our baseline assessment.”

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