Researchers evaluate chemo at the end of life
Less chemotherapy allows for better quality of life and easier transition toward death for cancer patients in the last phases of life, according to researchers at Virginia Commonwealth University Massey Cancer Center.1
About 15-20% of patients with incurable cancers in the United States receive chemotherapy within 14 days of their death. However, at this stage, the chemotherapy has virtually no beneficial effect, according to Thomas J. Smith, MD, and Sarah E. Harrington, MD.
Several factors lead researchers to conclude that chemotherapy toward the end of life may not be the best solution for many incurable patients. These factors include:
- Chemotherapy may have negative side effects, compromising the patients' sense of well being. People in hospice who do not receive chemotherapy live longer.
- Chemotherapy prevents patients from going into hospice.
- One in three families is bankrupted by serious illness.
- Patients receiving chemotherapy are likely to miss opportunities for spiritual growth, quality family time, travel, financial transitions, and passing on a "life review" for future generations.
The authors show that chemotherapy is given near the end of life in the United States more than in other countries. The contributing factors include:
- a lack of honest information about prognosis;
- hype from drug companies and national research organizations;
- people not believing their doctors or having a different perspective;
- doctors and patients wanting to avoid frank discussion about the issue;
- doctors in the United States, who are paid to prescribe chemotherapy and not to counsel patients and help them prepare for a "good death."
Smith and Harrington suggest that medical professionals should improve communication with their patients by providing honest and more detailed information. "Patients and their families want and need more information to transition toward the best death possible. This article provides several helpful sections to identify the appropriate goals of chemotherapy, to transition to palliative or hospice care, and to discuss prognoses in clear and effective manners with patients."
Reference
1. Harrington SE, Smith TJ. The role of chemotherapy at the end of life: "When is enough, enough?"" JAMA. 2008; 299:2,667-2,678.
Less chemotherapy allows for better quality of life and easier transition toward death for cancer patients in the last phases of life, according to researchers at Virginia Commonwealth University Massey Cancer Center.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content. TESTING
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