Introduction
Chemotherapy is used to treat metastatic cancer, with the goal
of palliating symptoms and improving survival. Between 20%
and 50% of patients with incurable cancers receive
chemotherapy within 30 days of death,1 2 despite growing
concerns that it may not be effective. Recently, the American
Society for Clinical Oncology identified end of life
chemotherapy as one of the “top five” practices that could
improve patients’ care and reduce costs, if stopped.3 Deciding
when to discontinue chemotherapy is often challenging,
however, given limited data on whether chemotherapy is helpful
or harmful in the final months of life.2-5
Research suggests that the use of chemotherapy within two
weeks of death is associated with lower rates of hospice use,6 7
but only 6.2% of patients receive chemotherapy this late.8 Most
decisions about treatment occur months before death, when data
to guide decision making about chemotherapy are more limited.
For example, in a randomized controlled study comparing early
palliative care integrated with oncology care versus standard
oncology care among patients newly diagnosed as having
metastatic lung cancer, Greer et al found that 62% of all enrolled
patients received chemotherapy within two months of death.9 10
However, patients who received concurrent palliative and
oncologic care stopped intravenous chemotherapy an average
of two months earlier than did those in the standard oncology
group but had a longer median overall survival and were more
likely to receive at least one week of hospice services.9 10 To
our knowledge, however, Greer at al’s study and others have
not specifically examined whether the use of chemotherapy in
the months leading up to the patient’s death is associated with
the subsequent receipt of intensive medical care in the last week
of life or death in an intensive care unit.
Introduction
Chemotherapy is used to treat metastatic cancer, with the goal
of palliating symptoms and improving survival. Between 20%
and 50% of patients with incurable cancers receive
chemotherapy within 30 days of death,1 2 despite growing
concerns that it may not be effective. Recently, the American
Society for Clinical Oncology identified end of life
chemotherapy as one of the “top five” practices that could
improve patients’ care and reduce costs, if stopped.3 Deciding
when to discontinue chemotherapy is often challenging,
however, given limited data on whether chemotherapy is helpful
or harmful in the final months of life.2-5
Research suggests that the use of chemotherapy within two
weeks of death is associated with lower rates of hospice use,6 7
but only 6.2% of patients receive chemotherapy this late.8 Most
decisions about treatment occur months before death, when data
to guide decision making about chemotherapy are more limited.
For example, in a randomized controlled study comparing early
palliative care integrated with oncology care versus standard
oncology care among patients newly diagnosed as having
metastatic lung cancer, Greer et al found that 62% of all enrolled
patients received chemotherapy within two months of death.9 10
However, patients who received concurrent palliative and
oncologic care stopped intravenous chemotherapy an average
of two months earlier than did those in the standard oncology
group but had a longer median overall survival and were more
likely to receive at least one week of hospice services.9 10 To
our knowledge, however, Greer at al’s study and others have
not specifically examined whether the use of chemotherapy in
the months leading up to the patient’s death is associated with
the subsequent receipt of intensive medical care in the last week
of life or death in an intensive care unit.
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