Difficult Choices When Dying of Cancer

Palliative chemotherapy may mean cancer patients do not die how they want

(RxWiki News) Planning ahead is a useful strategy in many aspects of life, even when it comes to the end of life.

A new study found that many cancer patients who received palliative chemotherapy may not have died the way they wanted.

Palliative chemotherapy is not meant to cure cancer, but rather to help with pain or other symptoms of the cancer. Many people who receive chemotherapy in the last few months of life are hoping it will buy them a bit more time.

While palliative chemotherapy can prolong survival, many patients who receive this therapy might not die where they want or may undergo undesirable medical interventions, such as cardiopulmonary resuscitation, this new research suggested.

"Discuss your end-of-life wishes with your family and medical team."

Close to 66 percent of dying cancer patients who were receiving palliative chemotherapy died at home, noted the study’s authors, led by Alexi Wright, MD, MPH, of the Dana-Farber Cancer Institute in Boston. This compares with 80 percent of those who were not receiving palliative chemotherapy.

Eleven percent of those receiving the chemotherapy died in the intensive care unit; whereas only 2 percent of people who did not receive palliative chemotherapy died there.

The researchers looked at data from 386 patients who were recruited between 2002 and 2008 for the Coping with Cancer study. Significantly more than half — 216 of the 386 patients — were receiving palliative chemotherapy when they started in the study, which averaged about four months before they died.

All of the patients had metastatic cancer (cancer that has spread) and had endured one regimen of chemotherapy that showed their cancer was resistant to treatment.

The researchers conducted an interview at the beginning of the study, and then used data from the patients’ medical charts. They also conducted interviews with the patients’ caregivers after the patients died.

The research showed that while 54 percent of the dying patients who received palliative chemotherapy were referred to hospice only a week or so before death (considered to be a late time for hospice), 37 percent of the dying who were not on palliative chemotherapy were referred at that late of a date.

Hospice is end-of-life care, and patients in hospice are often assisted to die the way they wish — for instance, in their own home with medical support.

In addition, 14 percent of those receiving palliative chemotherapy had a medical intervention, such as mechanical ventilation, in the week before they died. This was true of 2 percent of those who did not have chemotherapy.

The study's authors noted that many patients want palliative chemotherapy, even if it extends their life by only a week.

In this particular study, people with cancer who received the end-of-life chemotherapy did not live longer than others in the study.

Dr. Wright said in a press release, “Our finding that patients with terminal cancers were at higher risk of receiving intensive end-of-life care if they were treated with palliative chemotherapy months earlier underscores the importance of oncologists asking patients about their end-of-life wishes.”

“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 to ensure they receive the kind of care they want near death.”

The authors suggested that those who receive palliative chemotherapy may not understand its purpose, or the consequences of their choice. Participants in this study who chose palliative chemotherapy were less likely to talk to their oncologist about the care they would like if they are dying, less likely to complete a do not resuscitate order and less likely to acknowledge that they were dying.

This study was published March 4 in BMJ.

The research was funded by that National Cancer Institute and National Institute of Mental Health.

Review Date: 
March 6, 2014