Palliative chemotherapy: harms and benefits weighed in new study
Palliative chemotherapy is treatment designed for terminal cancer patients to prolong survival and ease symptoms but not cure disease. Now, researchers have found that the therapy comes with certain harms, which they say need to be addressed.
The researchers, from the Weill Cornell Medical College, Dana-Farber Cancer Institute and Harvard Medical School, have published their results in the BMJ.
They say their findings uncover a discrepancy between what type of care cancer patients want and what they actually receive.
Overall, the team found that terminal cancer patients who receive chemotherapy during the last months of their lives are less likely to die where they wish and are more likely to undergo invasive medical procedures - including CPR and mechanical ventilation - than patients who did not receive the therapy.
Dr. Holly Prigerson, of Weill Cornell Medical College, says that the reasons for the link are complicated, but they may originate in misunderstanding of the purpose and consequences of palliative chemotherapy.
For the study, investigators assessed data from 386 patients in a federally funded study, called Coping with Cancer.
This 6-year study followed terminally ill people and their caregivers until the patients died, and the researchers looked at how psychosocial factors influenced patient care.
After asking the caregivers to rate their patient's care, quality of life and where the patient would have wanted to die, the researchers reviewed patient medical charts to determine the type of care they actually received during their last week.
Chemotherapy patients less likely to die where they want
The researchers found that patients receiving palliative chemotherapy were less likely to talk to their oncologists about the type of care they wanted to receive, to complete Do-Not-Resuscitate orders or to even acknowledge they were terminally ill.
The findings reveal that 68% of patients receiving palliative chemotherapy died where they wanted, compared with 80% of those not receiving the therapy.
In detail, 47% of patients who received the therapy died at home, compared with 66% of patients who did not receive the palliative care. Additionally, 11% of patients receiving the chemotherapy died in an intensive care unit, versus only 2% of patients not receiving the therapy.
Dr. Prigerson says:
"It's hard to see in these data much of a silver lining to palliative chemotherapy for patients in the terminal stage of their cancer. Until now, there hasn't been evidence of harmful effects of palliative chemotherapy in the last few months of life."
"This study is a first step in proving evidence that specifically demonstrates what negative outcomes may result," she adds.
The team also found that patients receiving palliative chemotherapy were more likely to be referred to hospice care much later than those not receiving the therapy.
Hospice care is a place that provides comfort and emotional support for terminal patients, and 54% of the patients receiving chemotherapy were referred to hospice late, compared with 37% of the patients not receiving the drugs.
'Potential need for oncology practice changes'
The team notes that 56% of the patients from the study were receiving palliative chemotherapy in their final months, and they say this majority of use emphasizes the potential need for changes in oncology practice at academic medical centers.
Dr. Alexi Wright, assistant professor and medical oncologist at Dana-Farber, says:
"We often wait until patients stop chemotherapy before asking them about where and how they want to die, but this study shows we need to ask patients about their preferences while they are receiving chemotherapy to ensure they receive the kind of care they want near death."
But Dr. Wright adds that their findings should not be interpreted that patients should be denied or not offered palliative chemotherapy:
"The vast majority of patients in this study wanted palliative chemotherapy if it might increase their survival by as little as a week. This study is a step towards understanding some of the human costs and benefits of palliative chemotherapy."
"Additional studies are needed to confirm these troubling findings," concludes Dr. Prigerson.
Written by Marie Ellis
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