No Benefit from Chemo at End of Life
Written by Editor   
Thursday, July 30, 2015 10:05 AM

Chemotherapy administered near death makes "quality of life" and "quality of life near death" worse.  Equating treatment with hope is inappropriate. The battle analogy portrays the dying patient as a loser and should be discouraged.

ObservationsThis is a clarion call for oncologists, and for the medical profession in general, to take the lead in curtailing the use of ineffective therapy the authors note.  The hope for a dramatic cure is not evidenced by the results and the deterioration of quality of life.  

Potential actions: 

  • Be prepared to these share findings with the public.

  • Suggest that “near death” cancer patients discuss with their MD avoiding chemotherapy and instead focus on palliative care and improved function.

  • Consider that chiropractic care may be a suitable palliative and functional improvement therapy for many “end of life” cancer patients.

 

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.

"Results indicated that the association between chemotherapy use and worse QOL in the final week of life for patients with good perfromance status at the time of enrollment remained statistically significant even after adjustment for receipt of aggressive life-prolonging care," the authors said. "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."

Beyond the data, the study suggests that "equating treatment with hope is inappropriate. 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. 

"This is a clarion call for oncologists as individual practitioners, and for our profession in general, 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," authors concluded.


Source:  http://www.medpagetoday.com/PublicHealthPolicy/Ethics/52801