Which is worse cancer or chemotherapy

Chemo is more likely to harm

NEW YORK. Many end-stage cancer patients are still offered chemotherapy despite the lack of evidence.

It is said to prolong survival and improve the quality of life. But again and again doubts arise as to whether the person affected will actually help.

How chemotherapy affects the quality of life of cancer patients with different physical conditions in the last week of life, Dr. Holly Prigerson and her colleagues at the New York Presbyterian Hospital examined (JAMA Oncol 2015; online July 23).

A total of 661 end-stage cancer patients with an average age of 58.6 years were included in the cohort study from September 2002 to February 2008. 58 percent of the test persons died within the observation period of 3.8 months on average.

51 percent of patients with progressive metastatic disease received chemotherapy, especially those in good physical condition (ECOG score 1.6 vs. 2.0). After the death of a patient, the nursing staff was asked about their quality of life in the last week of life.

No influence on risk of death

In patients with an ECOG score of 2 or 3 points at the start of the study, chemotherapy did not improve the quality of life one week before death.

If, on the other hand, the physical condition was still good (ECOG 1), the condition worsened significantly as a result of the chemotherapy (odds ratio, OR 0.35). Chemotherapy had no discernible influence on the risk of death.

The authors' conclusion: The ASCO guidelines recommend that palliative chemotherapy should be considered in patients with end-stage metastatic carcinoma.

According to the study results, however, the question arises as to whom such a therapy is most harmful, according to Prigerson and colleagues.

Because it is precisely those who are still physically fittest who suffer the most severe deterioration in their quality of life as a result of chemotherapy. Overall, according to the authors, chemotherapy appears to do more harm than good to patients with terminal metastatic carcinoma.

No more active oncological treatment when death is near

Dr. Charles Blanke and Dr. Erik Fromme from Oregon Health and Science University in Portland emphasized in an accompanying comment that therapy and hope should not be equated (JAMA Oncology 2015, online July 23).

The last six months of a life should not be spent with largely ineffective therapies and their side effects.

If the death of a cancer patient is expected within the next six months, active oncological treatment should no longer be carried out, according to the oncologists.

However, if there is a valid reason for this, the conversation about prognosis, goals, fears and sustainable compromises that was made with the patient and his family should be documented.

The goal, according to Blanke and Fromme, is ultimately a good decision, with which the suffering is not exacerbated, especially in the last few weeks of life.

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