Chemo Use Does Not Improve Quality of Life Near Death

Though many patients with cancer are offered chemotherapy as palliative care during end-of-life treatment, its benefit has not been well studied previously.

A recent study led by Holly G. Prigerson looked at the association of chemotherapy use, quality of life (QOL) near death and patients’ performance status. Prigerson is the director of the Center for Research on End-of-Life Care at Weill Cornell Medical College.

Quality of Life Near Death With and Without Chemotherapy

Good, moderate or poor performance status based on Eastern Cooperative Oncology Group (ECOG) score. Higher (vs lower) quality of life near death according to baseline chemotherapy (or no chemotherapy).Adapted from: 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.

The study found that chemotherapy did not improve QOL for patients with end-stage cancer with moderate or poor performance status. Among patients with good performance status, QOL near death was worsened.

In total, 312 patients from six cancer clinics in the U.S. 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 QOL.

In addition to the main findings regarding the association between performance status, chemotherapy use and QOL, the authors also reported on risk of death. Risk of death, they wrote, was not significantly associated with the use of chemotherapy when evaluated overall nor within each performance status classification.

Results of the study, the authors wrote, show 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,” they concluded.