Study Finds More Hospital Deaths and Invasive Care for Terminal Cancer Patients Receiving Palliative Chemotherapy
Patients with terminal cancer who receive chemotherapy during the last months of their lives are less likely to die where they want and more likely to endure invasive medical procedures than those who do not receive chemotherapy, according to a study by Wright et al published in BMJ. The findings highlight the need for clearer discussions of palliative chemotherapy by physicians, patients, and family members.
Researchers from Dana-Farber Cancer Institute and Weill Cornell Medical College, analyzed the medical care of 386 adult patients enrolled in the Coping With Cancer cohort study of terminally ill cancer patients and their caregivers. The patients, whom physicians identified as terminally ill at study enrollment and who subsequently died, had metastatic cancers refractory to at least one chemotherapy regimen.
Study Results
The study findings show that 216 (56%) of the 386 terminally ill cancer patients were receiving palliative chemotherapy at study enrollment, a median of 4.0 months before death. After propensity score–weighted adjustment, use of palliative chemotherapy was associated with an increased risk of undergoing mechanical ventilation, cardiopulmonary resuscitation, or both in the last week of life (14% vs 2%; adjusted risk difference 10.5%, 95% confidence interval [CI] = 5.0%–15.5%). Use of palliative chemotherapy was also associated with late hospice referrals (54% vs 37%; adjusted risk difference 13.6%, 95% CI = 3.6%–23.6%), but no difference in survival (hazard ratio = 1.11, 95% CI = 0.90–1.38).
Patients receiving palliative chemotherapy were also more likely to die in an intensive care unit (11% vs 2%; adjusted risk difference = 6.1%, 95% CI = 1.1%–11.1%) and less likely to die at home (47% vs 66%; adjusted risk difference = –10.8%, 95% CI = –1.0% to –20.6%), compared with those who were not. They were also less likely to die in their preferred place, compared with those who were not receiving palliative chemotherapy (65% vs 80%; adjusted risk difference = –9.4%, 95% CI = –0.8% to –18.1%).
In addition, patients receiving palliative chemotherapy were more likely to express a preference to receive “life-extending” care over comfort care (39% vs 26%, P = .01), including chemotherapy if it might extend their life by 1 week (86% vs 60%, P < .001, compared with those not receiving chemotherapy.
Importance of End-of-Life Discussions
“Our finding that patients who received palliative chemotherapy were at risk of receiving more aggressive end-of-life care underscores the importance of oncologists asking patients about their end-of-life wishes,” Alexi A. Wright, MD, MPH, lead author of the study and Assistant Professor and medical oncologist at Dana-Farber Cancer Institute, said in a statement. “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.”
Holly G. Prigerson, PhD, of Weill Cornell Medical College, is the corresponding author of the BMJ article.
The study was funded by the National Cancer Institute and the National Institute of Mental Health. The study authors reported no potential conflicts of interest.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
