Chemotherapy Guidance at the End-of-Life

Researchers from the Virginia Commonwealth University Massey Cancer Center examined the use of chemotherapy given to cancer patients in the U.S. at the end of life. In a news release about the research, which appears in the Journal of the American Medical Association (JAMA), the authors conclude chemotherapy may not be the best solution and suggest discussing hospice care with patients. From the news release:

Taking several other factors into account, 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 not receiving 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 to pass 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 are paid to prescribe chemotherapy; they are not paid to counsel patients and help them prepare for a “good death.”

“As doctors we are taught to save lives, and much of our training and practice is geared toward that effort,” said Smith. “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.”

The solutions Smith and Harrington present to the medical profession include:

• More honest communication from the beginning with patients


• Bring up hospice


• Ask people what they want to know, and tell them

Also see coverage of the research from USAToday and Pallimed.