Doctors raise concern about chemo for end-stage cancer

MIAMI: Giving chemotherapy to people with terminal cancer who are near the end of their lives is likely to cause more harm than good, according to a US study Thursday.

The findings in the Journal of the American Medical Association (JAMA) Oncology are based on a group of more than 300 patients with metastatic cancer, meaning their tumors had spread from the initial site in the body to other organs, and had become incurable.

About half of the patients were on chemotherapy, which delivers potent chemicals into the body to destroy cancer cells and shrink tumors. Side effects can include weakness, nausea, fatigue, confusion and hair loss.

Most of the patients were men and their average age was 59. They had about four months to live.

The aim of the study was to examine how chemotherapy affected quality of life when the patients were near the end of their lives, particularly regarding their ability to walk, do work and take care of basic needs.

Based on caregivers' assessments of patients' physical and mental distress in their final week of life, researchers found that chemotherapy did not improve quality of life for patients who already had limited mobility.

And for those who were still able to perform basic life functions, chemotherapy made their quality of life worse.

"Not only did chemotherapy not benefit patients regardless of performance status, it appeared most harmful to those patients with good performance status," said the study led by Holly Prigerson of Weill Cornell Medical College and New York Presbyterian Hospital.

The study suggested that "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."

The article also pointed out that a 2012 expert panel to the American Society of Clinical Oncology (ASCO) had "described chemotherapy use among patients for whom there was no evidence of clinical value as the most widespread, wasteful, and unnecessary practice in oncology."

Chemotherapy is sometimes given to terminal cancer patients in a bid to shrink tumors that might be causing pain, a practice known as palliative chemotherapy.

An accompanying editorial in the journal by doctors Charles Blanke and Erik Fromme of the Oregon Health and Science University, argued that changing guidelines for chemo use across the board is not the right solution.

Rather, they urged doctors to counsel advanced cancer patients against pursuing chemotherapy in their final months of life.

"Equating treatment with hope is inappropriate. Even when oncologists communicate clearly about prognosis and are honest about the limitations of treatment, many patients feel immense pressure to continue treatment," the editorial said.

"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, but if an oncologist suspects the death of a patient in the next six months, the default should be no active treatment."