Chemo May Worsen Quality of Life for End-Stage Cancer Patients

Chemotherapy for patients with end-stage cancer was associated with worse quality of life near death for patients with a good ability to still perform many life functions, according to an article published online by JAMA Oncology. Patients who were less healthy at the study’s outset generally saw no effect from the treatment one way or the other.

Leading author of the study and Director of the Center for Research on End-of Life Care at Weill Cornell Medical College, Holly Prigerson said, “For oncologists, the default seems to be if a patient can tolerate another chemotherapy regimen, there’s a perception or the conventional wisdom is there is no harm in trying”.

Palliative care can include hospice services – typically given to people in the last six months of life – but also can be provided as soon as patients as diagnosed with a life-limiting illness.

Doctors should only prescribe chemo for these patients after talking to patients about their “prognosis, goals, fears and acceptable trade-offs”, they wrote.

At the end of the six-month period during which the respondents have been carefully observed, scientists have concluded that chemotherapy does not have a significant impact on cancer patients.

About half of the patients were on chemotherapy, which delivers potent chemicals into the body to destroy cancer cells and shrink tumors. Chemotherapy does not improve a patient’s quality of life; in fact, it does the exact opposite.

Those results suggest that doctors should consider changing their guidelines for care of cancer patients near the end of life, Prigerson said. Among those who were not receiving chemotherapy, 70 percent had a high quality of life score. They had about four months to live. Another study found that only a fraction of patients with advanced lung cancer understood that chemo was unlikely to cure them. For that reason, he believes chemotherapy should continue to remain a second option for end-stage cancer patients.

Christopher Johnson, who died in 2012 at 39 from a rare kidney cancer, received late-stage chemotherapy because he “wanted to do anything he could to prolong his life”, said his mother, Ritchie Johnson, of Sugar Land, Tex.

“The thinking has been ‘these patients have nothing to lose, ‘” Prigerson said.

How effective is palliative chemotherapy?

The aim of the study was to examine how chemotherapy affected quality of life when the patients were near the end of their lives, particularly regarding their ability to walk, do work and take care of basic needs. And about two weeks after the patients’ deaths, a family member or other caregiver rated the patients’ quality of life during the last week before death.

“If you give someone who is that sick toxic chemotherapy, they’re going to feel bad”.

It is an excruciating question for cancer patients with a prognosis of months to live: Should they try another round of chemotherapy? “If you give Superman Kryptonite, his super powers will go away and if you give a person something poisonous, they’re not going to be feeling better”.

She and her colleagues wrote that American Society of Clinical Oncology (ASCO) guidelines “regarding chemotherapy use in patients with terminal cancer may need to be revised to recognize the potential harm of chemotherapy use in patients with progressive metastatic disease”. Prigerson hopes the new study will help raise the question of whether that is appropriate, since it may make patients feel worse.