Palliative Chemo May Worsen QOL Near Death

Pharmacists should reconsider recommending toxic chemotherapy for cancer palliation because it may significantly worsen terminal cancer patients’ quality of life near death (QOD), according to the only study to measure these effects to date.

This prospective, multi-institutional cohort study enrolled 661 cancer patients whose physicians estimated that they had only 6 months or fewer to live. Patients who could not speak English or Spanish or had serious cognitive impairment were excluded.

The study authors evaluated the association between palliative chemotherapy and QOD as a function of patients’ performance status, which was scored using the Eastern Cooperative Oncology Group (ECOG) Performance Status, where higher scores indicated worse physical impairment.

QOD was measured by asking close caregivers to rate the patients’ quality of life 1 week prior to their death. Of the 661 patients enrolled, 384 died within the study period.

Those with better performance status at baseline who received chemotherapy had significantly worse QOD, but there was no statistical difference in QOD between the chemotherapy and non-chemotherapy groups in patients with worse performance status at baseline. Only 43% of patients receiving palliative chemotherapy had good QOD compared with 69% who didn’t receive chemotherapy.

This study didn’t identify chemotherapy agents or duration of treatment, nor did it differentiate QOD by cancer type. While more research is needed to determine which chemotherapy regimens may be useful in palliative care, this study calls into question the widespread practice of aggressively treating terminally ill patients.

It was published in JAMA Oncology.