Chemo and End-stage Cancer: Is it Worth it?
Even in patients with a good performance status, quality of life near death is not improved and can even be worsened by chemotherapy use.
Even in patients with a good performance status, quality of life near death (QOD) is not improved and can even be worsened by chemotherapy use, according to an article published online ahead of print in JAMA Oncology.
American Society of Clinical Oncology guidelines recommend palliative chemotherapy only for solid tumor patients with good performance status.
Although patients with end-stage cancer are offered chemotherapy, its association with quality of life amid progressive metastatic disease has not been well-studied.
A multi-institutional, longitudinal cohort study of patients with end-stage cancer was conducted. A total of 312 patients with end-stage cancer were recruited between September 2002 and February 2008.
Chemotherapy use (n=158; 50.6%) and Eastern Cooperative Group (ECOG) Status were assessed at baseline (median 3.8 months prior to death).
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Patients with progressive metastatic cancer receiving at least one chemotherapy regimen were followed until death at six outpatient oncology clinics.
QOD was determined using validated caregiver ratings of patients' physical and mental distress in their final week.
Results showed that chemotherapy use was not associated with patient survival controlling for clinical setting and patients' performance status. Palliative chemotherapy worsened QOD for patients with good performance status and did not improve it for patients with moderate or poor performance status.