Palliative chemo patients' end-of-life wishes overlooked
Terminal patients receiving chemotherapy less likely to die at home
Terminal cancer patients who receive chemotherapy in the last months of their lives are less likely to die where they want and are more likely to undergo highly invasive medical procedures, a study says.
A team of researchers from Harvard Medical School, the Weill Cornell Medical College and the Dana-Farber Cancer Institute discovered that only 68 per cent of patients who received palliative chemotherapy — designed to ease symptoms and prolong survival but not to cure — died in the place they wanted.
By contrast, 80 per cent of patients who did not get palliative chemotherapy died in the place they wished. And in this group, 66 per cent died at home.
But in the palliative chemotherapy group, 47 per cent died at home.
“Until now, there hasn’t been evidence of harmful effects of palliative chemotherapy in the last few months of life,” said the study’s senior author Dr. Holly Prigerson. “This study is a first step in providing evidence that specifically demonstrates what negative outcomes may result.”
The study, published in BMJ (formerly the British Medical Journal), followed 386 adult patients of varying ages from eight oncology clinics across the U.S. for a period of six years, from 2002 to 2008.
The patients were identified by their physicians as having six months or less to live.
Not acknowledging illness was terminal
The researchers were provided information about the patients including their medical charts, physical functioning, treatment preferences, quality of life and end-of-life decision-making with their physician in the last week of the patient’s life.
In addition, a month after the patient’s death, the individual’s caregiver was asked about the patient’s quality of life and care and whether the place of death was where the patient would have wanted to die.
Prigerson, from Weill Cornell Medical College, said patients getting that type of chemotherapy may misunderstand why they are getting it and may not know that it’s not curing their condition.
Patients getting palliative chemotherapy were:
- Less likely to acknowledge their illness was terminal.
- Less likely to discuss end-of-life wishes with their physician.
- Less likely to have completed a do-not-resuscitate order.
“We often wait until patients stop chemotherapy before asking them about where and how they want to die, but this study shows we need to ask patients about their preferences while they are receiving chemotherapy,” said Dr. Alexi Wright, a study co-author.
The researchers also discovered those getting the palliative chemotherapy were also more likely to undergo intensive medical interventions including mechanical ventilation or cardiopulmonary resuscitation.
Prigerson says the study will help doctors understand the human costs of “very aggressive, life-prolonging care at the expense of … quality of life.”