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.
Holly G. Prigerson, of Weill Cornell Medical College in New York, NY, and colleagues publish their findings in JAMA Oncology.
According to the team, physicians have spoken out about concerns related to the use of chemotherapy among cancer patients who are near death.
They point to an American Society of Clinical Oncology (ASCO) expert panel who – in 2012 – cited chemotherapy in near-death cancer patients as “the most widespread, wasteful, and unnecessary practice in oncology,” after finding lack of evidence that such treatment is beneficial.
However, Prigerson and colleagues note that cancer patients nearing death continue to be offered chemotherapy – particularly those who are more active with better self-care ability.
For their study, the team set out to gain a better understanding of how the treatment impacts the quality of life for end-stage cancer patients.
Between September 2002 and February 2008, the researchers assessed 312 patients with terminal cancer who were estimated to have a life expectancy of 6 months or less.
At study baseline, more than half of patients were receiving chemotherapy. The performance status of patients – that is, their activity levels and self-care capabilities – were evaluated and scored. The higher their score, the worse their performance status.
Compared with patients who did not receive chemotherapy, those with a poor performance status who received the treatment experienced no improvement in quality of life in their final week before death.
What is more, the quality of life for chemotherapy-treated patients with a good performance status worsened in their final week, compared with patients with a good performance status who did not receive the treatment.
At present, guidelines from ASCO claim patients with terminal cancer who have a good performance status are the ones most likely to benefit from chemotherapy. These latest findings, however, suggest the opposite.
“Results of this study suggest that chemotherapy use among patients with chemotherapy-refractory metastatic cancer is of questionable benefit to patients’ QOL [quality of life] in their final week,” say Prigerson and colleagues, adding:
“Not only did chemotherapy not benefit patients regardless of performance status, it appeared most harmful to those patients with good performance status.
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.”
However, in an editorial linked to the study, Drs. Charles D. Blanke and Erik K. Fromme, of the Oregon Health and Science University, say it is too soon to suggest a change in ASCO guidelines.
“At this time, it would not be fitting to suggest guidelines must be changed to prohibit chemotherapy for all patients near death without irrefutable data defining who might actually benefit,” they add, “but if an oncologist suspects the death of a patient in the next 6 months, the default should be no active treatment.”
Earlier this month, Medical News Today reported on a study published in Cell, in which researchers detailed a new technique that uses light to activate chemotherapy drugs in certain cancer cells, which may boost the effectiveness of cancer treatment.