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End Stage Chemotherapy

Posted 8/3/2015

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  This title, End Stage Chemotherapy, seems like an oxymoron or at least feels odd. Isn't chemotherapy, at its most effective, hoped to be curative and, whenever given, hoped to reduce or slow tumor growth and extend life? I would have thought the answer was "yes", but chemo is sometimes given either in palliation (and that would be in the hopes of reducing symptoms--e.g. shrinking lung tumors so that someone can breathe more easily) or as a very last ditch effort to slow down, in Anne Sexton's words, the awful rowing toward God.

  As we learn more about this, it turns out that chemo is given, not infrequently, to terribly ill people. There is too often little chance of much benefit and a much bigger chance of uncomfortable side effects, high expense, and a diminished QOL. I wrote last week about a recently published study that shared these results. This has resulted in a fire storm of passionate discussion.

  Careful warning here: I have absolutely learned over the past few years that none of us have the slightest idea what we would choose to do in this situation. I had two very dear friends, an oncologist and a psychologist who did similar work to mine, who both died of cancer three years ago. Both had spent their careers thoughtfully discussing this painful situation with their patients, helping people, when it was appropriate, to decide to stop treatment and concentrate on the quality of their remaining time. When they themselves were dying, they both chose to try absolutely anything that might delay the inevitable by even a few days. Their choices quickly sobered me up and convinced me that we have no right to ever think we know best or to assume we know what we would do or plead with someone beloved to choose.

  This is a tricky and painful and unclear topic, but it is one that we need to consider. Here are remarks from BreastCancer.org; they include a link to the original journal article.

Does End-Stage Chemotherapy Improve Quality of Life?

The question of when to stop treatment for people with metastatic disease that continues to grow despite all efforts is a gut-wrenching choice. It’s very hard to make the transition from fighting the disease to beginning to think about how to for the end of life. The challenge is extremely painful for both the person diagnosed with cancer and her/his loved ones.
In many cases, people with end-stage metastatic cancer are offered chemotherapy to ease pain and improve their quality of life. When chemotherapy is given for these reasons, it’s called palliative chemotherapy. Still, not much research has looked at whether palliative chemotherapy for end-stage disease actually does improve quality of life.
A study suggests that few people benefit from end-of-life chemotherapy and many people have worse quality of life after receiving it.
The study was published online on July 23, 2015 by JAMA Oncology. Read the abstract of “Chemotherapy Use,Status, and Quality of Life at the End of Life.” (NOTE; FOLLOW THE LINK AT THE END OF THIS EXCERPT TO THE FULL ARTICLE; IT INCLUDES THIS LINK)
Guidelines from the American Society of Clinical Oncology (ASCO) recommend that palliative chemotherapy not be given to people diagnosed with growing metastatic disease who are very sick and bedridden and who can’t take care of their own daily needs. For people diagnosed with growing metastatic cancer who are in relatively good health and self-sufficient,
ASCO guidelines recommend trying palliative chemotherapy to ease pain or help the person live longer.

http://www.breastcancer.org/research-news/end-stage-chemo-for-quality-of-life


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