Palliative chemotherapy ignores cancer patient's last wishes


Terminally ill cancer patients who continue to receive chemotherapy months prior to their death won't likely die in the place they want, a new study has found. Cancer patients who receive palliative chemotherapy, which is given not to cure the disease but simply to prolong survival and ease the symptoms, are also more likely to end up dying in an intensive care unit (ICU) than their counterparts.

In a study published in BMJ March 4, researchers wanted to find out if terminal cancer patients receiving chemotherapy months prior to their death were more likely to receive invasive medical procedures in the last weeks of their lives and die in the intensive care unit than cancer patients who did not receive palliative chemotherapy.

The researchers followed more than 300 cancer patients, who were identified by their doctors to be terminally ill and subsequently died. They found that of the patients who underwent palliative chemotherapy, only 68 percent died in the place that they wanted. Eighty percent of the patients who did not get palliative chemotherapy, on the other hand, died in the place that they wanted with 66 percent of them dying at home. The researchers also found that the patients who had palliative chemotherapy were more likely to die in an intensive care unit than their counterparts.

"The use of chemotherapy in terminally ill cancer patients in the last months of life was associated with an increased risk of undergoing cardiopulmonary resuscitation, mechanical ventilation or both and of dying in an intensive care unit," the researchers said. "Future research should determine the mechanisms by which palliative chemotherapy affects end of life outcomes and patients' attainment of their goals."

Study author Holly Prigerson, a professor of medicine at the Weill Cornell Medical College in New York said their study shows evidence of the negative implications of terminally ill patients receiving palliative chemotherapy.

"It's hard to see in these data much of a silver lining to palliative chemotherapy for patients in the terminal stage of their cancer," Prigerson said. "Until now, there hasn't been evidence of harmful effects of palliative chemotherapy in the last few months of life. This study is a first step in providing evidence that specifically demonstrates what negative outcomes may result. "

The researchers, however, said the result of their study does not suggest that cancer patients be denied palliative chemotherapy. "The vast majority of patients in this study wanted palliative chemotherapy if it might increase their survival by as little as a week," said study lead author Alexi Wright, an assistant professor of medicine at Dana-Farber Cancer Institute in Boston. "This study is a step towards understanding some of the human costs and benefits of palliative chemotherapy."

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