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Chemotherapy and End-Stage Cancer

Does chemotherapy improve QOL near death?

Publish date:: August 11, 2015

Chemotherapy use for patients with end-stage cancer does not improve quality of life near death (QOD) and actually can decrease quality of life, according to a cohort study of 158 patients with end-stage cancer. Performance status was assessed at baseline (median was 3.8 months before death) in patients with progressive metastatic cancer (n=312) and patients who received at least 1 chemotherapy regimen were followed until death. Further study details indicated:

• Among patients with good baseline performance status, chemotherapy use compared with nonuse was associated with worse QOD.

• Baseline chemotherapy use was not associated with QOD among patients with moderate or poor baseline performance status.

Citation: Prigerson HG, Bao Y, Shah MA, et al. Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol. [Published online ahead of print July 23, 2015]. doi: 10.1001/jamaoncol.2015.2378.

Commentary: When making a new diagnosis of end-stage advanced cancer, we have a natural desire to offer the patient something to make them better, and what is often offered is chemotherapy. At the same time, depending upon the clinical situation, this is in conflict with our desire to help the patient as best as we can with relief of pain and clarity of prognosis. This article is helpful in showing that, for patients with a diagnosis of advanced end-stage cancer, chemotherapy may not be beneficial, and in fact may be harmful. While this is not a surprise to any experienced clinician, seeing evidence that this is in fact the case is helpful in formulating treatment plans and discussing options with patients. —Neil Skolnik, MD

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