Chemotherapy Does Not Improve Quality of Life for Patients With End-Stage Disease

A new study is raising questions about the benefits of chemotherapy for patients with end-stage cancer, finding that in terms of quality of life, for many patients it does more harm than good.

Holly G. Prigerson

A new study is raising questions about the benefits of chemotherapy for patients with end-stage cancer, finding that in terms of quality of life, for many patients it does more harm than good.

Researchers, led by Holly G. Prigerson, director of the Center for Research on End-of-Life Care at Weill Cornell Medical College, explored the association between chemotherapy use, quality of life near death (QOD), and patients’ performance status and found that chemotherapy did not improve QOD for patients with end-stage cancer with moderate or poor performance status.

And, notably, among patients with good performance status, QOD was worsened with chemotherapy.

In total, 312 patients from six cancer clinics in the United States participated in the study. Patients were recruited between September 2002 and February 2008. At the time of enrollment—a median of 3.8 months before death—50.6% of patients were receiving chemotherapy.

Researchers interviewed caregivers a median of 2.4 weeks after each patient’s death. Caregivers were asked to rate on a scale from 1-10 the patient’s level of psychological distress, physical distress, and overall QOD.

For patients with good baseline performance status (defined as Eastern Cooperative Oncology Group [ECOG] 1), QOD with chemotherapy use was 43.7% higher among those who received chemotherapy versus 68.6% higher in patients who did not receive chemotherapy. Additionally for patients with ECOG status 2 (moderate) and 3 (poor), chemotherapy use was not linked to higher QOD.

Study authors also reported on the impact of chemotherapy use on risk of death. They found that risk of death was not significantly associated with the use of chemotherapy when evaluated overall, nor within each performance status classification.

These results, the authors noted, suggest that chemotherapy use is questionable in a patient’s final week of life.

“Not only did chemotherapy not benefit patients regardless of performance status, it appeared most harmful to those patients with good performance status.”

In a related commentary on the study, Charles D. Blanke, MD, and Erik K. Fromme, MD, both of Oregon Health & Sciences University, noted that although these data “suggest that equating treatment with hope is inappropriate, even when oncologists communicate clearly about prognosis and are honest about the limitations of treatment, many patients feel immense pressure to continue treatment … At this time, it would not be fitting to suggest guidelines must be changed to prohibit chemotherapy for all patients near death without irrefutable data defining who might actually benefit, but if an oncologist suspects the death of a patient in the next six months, the default should be no active treatment.”

Prigerson HG, Bao Y, Shah MA, et al. Chemotherapy use, performance status, and quality of life at the end of life [published online July 23, 2015]. JAMA Oncol.