The first rule of medicine is to do no harm. A new study evaluated the benefits versus harms for patients with advance cancers. They assessed the quality of life with and without the use of chemotherapy. They published their findings online in the journal JAMA Oncology on July 23.
The study authors noted that, although many patients with end-stage cancer are offered palliative chemotherapy to improve their quality of life, the relationship between chemotherapy and quality of life amid progressive cancer has not been well-studied. (Palliative chemotherapy is not meant to be curative; rather, it is meant to ease symptoms.) Therefore, they conducted a study to evaluate the association between chemotherapy use and quality of life near death as a function of patients’ performance status.
The study was conducted six US outpatient oncology clinics on patients with end-stage cancer from September 2002 through February 2008. A total of 158 patients (50.6%) were receiving chemotherapy and 312 were not. Performance status was evaluated at baseline until death. The patients’ quality of life was determined with the use of validated caregiver ratings of the patients’ physical and mental distress in their final week.
The researchers found that chemotherapy use was not related to patient survival, meaning that it did not improve survival. Among patients who enjoyed a good quality of life at baseline performance status, chemotherapy use compared with nonuse was associated with a poorer quality of life overall and quality of life near death. .
The authors concluded that, although palliative chemotherapy is used to improve quality of life for patients with end-stage cancer, its use did not improve quality of life near death for patients with moderate or poor performance status and worsened quality of life near death for patients with good performance status. Therefore, the quality of life near death 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.
The authors are affiliated with Weill Cornell Medical College, New York, New York; Duke University School of Medicine, Durham, North Carolina; University of Texas Southwestern Medical Center, Dallas; University of Michigan Comprehensive Cancer Center, Ann Arbor; James J. Peters VA Medical Center, Bronx, New York; Icahn School of Medicine at Mount Sinai, New York, New York; New York Presbyterian Hospital-Weill Cornell Center, New York; Columbia University, New York, New York; and Yale University School of Medicine, New Haven, Connecticut.