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JAMA Oncol. 2015 Sep;1(6):778-84. doi: 10.1001/jamaoncol.2015.2378.

Chemotherapy Use, Performance Status, and Quality of Life at the End of Life.

Author information

1
Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York2Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York.
2
Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
3
Meyer Cancer Center of Weill Cornell Medical College, Medical Oncology/Solid Tumor Program, New York, New York.
4
Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
5
Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
6
University of Michigan Comprehensive Cancer Center, Ann Arbor.
7
James J. Peters VA Medical Center, Bronx, New York9Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
8
Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York.
9
Department of Medicine, Medical Intensive Care Unit, New York Presbyterian Hospital-Weill Cornell Center, New York.
10
Smilow Cancer Hospital at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut.
11
Department of Medicine and Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York12Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
12
Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York14Department of Radiology, Weill Cornell Medical College, New York, New York.

Abstract

IMPORTANCE:

Although many patients with end-stage cancer are offered chemotherapy to improve quality of life (QOL), the association between chemotherapy and QOL amid progressive metastatic disease has not been well-studied. American Society for Clinical Oncology guidelines recommend palliative chemotherapy only for solid tumor patients with good performance status.

OBJECTIVE:

To evaluate the association between chemotherapy use and QOL near death (QOD) as a function of patients' performance status.

DESIGN, SETTING, AND PARTICIPANTS:

A multi-institutional, longitudinal cohort study of patients with end-stage cancer recruited between September 2002 and February 2008. Chemotherapy use (n = 158 [50.6%]) and Eastern Cooperative Oncology Group (ECOG) performance status were assessed at baseline (median = 3.8 months before death) and patients with progressive metastatic cancer (N = 312) following at least 1 chemotherapy regimen were followed prospectively until death at 6 outpatient oncology clinics in the United States.

MAIN OUTCOMES AND MEASURES:

Patient QOD was determined using validated caregiver ratings of patients' physical and mental distress in their final week.

RESULTS:

Chemotherapy use was not associated with patient survival controlling for clinical setting and patients' performance status. Among patients with good (ECOG score = 1) baseline performance status, chemotherapy use compared with nonuse was associated with worse QOD (odds ratio [OR], 0.35; 95% CI, 0.17-0.75; P = .01). Baseline chemotherapy use was not associated with QOD among patients with moderate (ECOG score = 2) baseline performance status (OR, 1.06; 95% CI, 0.51-2.21; P = .87) or poor (ECOG score = 3) baseline performance status (OR, 1.34; 95% CI, 0.46-3.89; P = .59).

CONCLUSIONS AND RELEVANCE:

Although palliative chemotherapy is used to improve QOL for patients with end-stage cancer, its use did not improve QOD for patients with moderate or poor performance status and worsened QOD for patients with good performance status. The QOD in patients with end-stage cancer is not improved, and can be harmed, by chemotherapy use near death, even in patients with good performance status.

PMID:
26203912
PMCID:
PMC4828728
DOI:
10.1001/jamaoncol.2015.2378
[Indexed for MEDLINE]
Free PMC Article

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