Palliative Chemotherapy Can Worsen Quality of Life in End-Stage Cancer Patients

End-stage cancer patients who were in general the healthiest and most active displayed worse quality of life signs in their last week of life when they were given palliative chemotherapy and there were no benefits to overall survival.

Many clinical practices and oncologists believe that treating terminally ill cancer patients who may be have 6 months or less of life with chemotherapy may ease symptoms and extend life expectancy. However, researchers with the Weill Cornell Medical College say otherwise.

Researchers found in a recent study that end-stage cancer patients who were in general the healthiest and most active displayed worse quality of life signs in their last week of life when they were given palliative chemotherapy and there were no benefits to overall survival.

"This study demonstrates that palliative chemotherapy does not appear to palliate symptoms even in the most robust patients who can tolerate chemotherapy," Holly G. Prigerson, PhD, co-director of the Center for Research on End-of-Life Care and the Irving Sherwood Wright Professor in Geriatrics at Weill Cornell, said in a statement. "It raises questions about the rationale for such aggressive, burdensome care."

In examining 661 patients with advanced metastatic disease and cancer progression, researchers employed a scale to determine the patients’ health and functioning a few months prior to their passing and then conducted interviews with the patient’s most closely involved caregivers a week after death to understand physiological and physical distress and overall quality of life.

Among their results, the authors found that the quality of life in end-stage patients near death did not improve and in some cases worsened with palliative chemotherapy treatment, even in patients who showed good performance and healthy activity in the beginning of their cancer development.

“ASCO [The American Society for Clinical Oncology] has attempted to respond to the need to limit widespread, wasteful, and unnecessary treatment practices in formulating guidelines to restrict care only to patients with cancer expected to benefit from it,” the authors wrote. "Our results raise questions about the benefits and use of chemotherapy in patients in the end-stage of their illness regardless of their performance status.”