Background: A majority of end-stage cancer patients are receiving chemotherapy, regardless of performance status, in the last months of life. Oncologists continue to prescribe disease targeted therapy for patients enrolled in palliative or hospice care in an attempt to alleviate symptoms and extend life expectancy. Research indicates that chemotherapy at end of life does not accomplish either of these goals of care, and may actually do more harm than good.
Methods: An evidence based research review indicates that > 50% of all cancer patients are receiving chemotherapy during their last 4-6 months of life. Data supports a decreased quality of life and decreased life expectancy for patients receiving chemotherapy during the last months of life. There is an increase in visits to the emergency department, hospitalizations, and death in the hospital when cancer patients are actively receiving chemotherapy during end of life.
Overutilization of chemotherapy treatment is poor quality care leading to adverse patient outcomes. The intent of hospice care is to meet the physical, emotional, social, and spiritual needs of a dying patient and their family. The focus of care is on comfort, not cure. The intent of palliative care focuses on symptom control and may include a combination of comfort measures and curative interventions. This review supports further investigation into the practice of chemotherapy administration in terminally ill patients.
