Chemotherapy for near-death cancer patients does not improve “quality of life”

Chemotherapy Use, Performance Status, and Quality of Life at the End of Life

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Many patients with terminal cancer are offered chemotherapy in order to improve their quality of life. But according to a new study, the treatment does not improve quality of life for cancer patients who are near death – and may even worsen it for those who have good performance status. Chemotherapy drug by Nicki Dugan Pogue.

2015 Study Abstract

Although many patients with end-stage cancer are offered chemotherapy to improve quality of life (QOL), the association between chemotherapy and QOL amid progressive metastatic disease has not been well-studied. American Society for Clinical Oncology guidelines recommend palliative chemotherapy only for solid tumor patients with good performance status.

To evaluate the association between chemotherapy use and QOL near death (QOD) as a function of patients’ performance status.

Design, Setting, and Participants
A multi-institutional, longitudinal cohort study of patients with end-stage cancer recruited between September 2002 and February 2008. Chemotherapy use (n = 158 [50.6%]) and Eastern Cooperative Oncology Group (ECOG) performance status were assessed at baseline (median = 3.8 months before death) and patients with progressive metastatic cancer (N = 312) following at least 1 chemotherapy regimen were followed prospectively until death at 6 outpatient oncology clinics in the United States.

Main Outcomes and Measures Patient QOD was determined using validated caregiver ratings of patients’ physical and mental distress in their final week.

Chemotherapy use was not associated with patient survival controlling for clinical setting and patients’ performance status. Among patients with good (ECOG score = 1) baseline performance status, chemotherapy use compared with nonuse was associated with worse QOD (odds ratio [OR], 0.35; 95% CI, 0.17-0.75; P = .01). Baseline chemotherapy use was not associated with QOD among patients with moderate (ECOG score = 2) baseline performance status (OR, 1.06; 95% CI, 0.51-2.21; P = .87) or poor (ECOG score = 3) baseline performance status (OR, 1.34; 95% CI, 0.46-3.89; P = .59).

Conclusions and Relevance
Although palliative chemotherapy is used to improve QOL for patients with end-stage cancer, its use did not improve QOD for patients with moderate or poor performance status and worsened QOD for patients with good performance status. The QOD in patients with end-stage cancer is not improved, and can be harmed, by chemotherapy use near death, even in patients with good performance status.

Sources and more information
  • Chemotherapy Use, Performance Status, and Quality of Life at the End of Life, JAMA Oncology Published online July 23, 2015. doi:10.1001/jamaoncol.2015.2378, July 23, 2015.
  • Chemotherapy for near-death cancer patients ‘does not improve quality of life’, MedicalNewsToday, 24 July 2015.

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