Chemotherapy Use, Performance Status, and Quality of Life at the End of Life. Academic Article Article uri icon

Overview

MeSH

  • Adult
  • Aged
  • Chi-Square Distribution
  • Female
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Metastasis
  • Neoplasm Staging
  • Odds Ratio
  • Patient Selection
  • Proportional Hazards Models
  • Prospective Studies
  • Risk Assessment
  • Risk Factors
  • Stress, Psychological
  • Time Factors
  • Treatment Outcome
  • United States

MeSH Major

  • Antineoplastic Agents
  • Health Status
  • Health Status Indicators
  • Neoplasms
  • Palliative Care
  • Quality of Life
  • Surveys and Questionnaires
  • Terminal Care

abstract

  • 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. To evaluate the association between chemotherapy use and QOL near death (QOD) as a function of patients' performance status. 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. Patient QOD was determined using validated caregiver ratings of patients' physical and mental distress in their final week. 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). 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.

publication date

  • September 2015

has subject area

  • Adult
  • Aged
  • Antineoplastic Agents
  • Chi-Square Distribution
  • Female
  • Health Status
  • Health Status Indicators
  • Humans
  • Logistic Models
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Metastasis
  • Neoplasm Staging
  • Neoplasms
  • Odds Ratio
  • Palliative Care
  • Patient Selection
  • Proportional Hazards Models
  • Prospective Studies
  • Quality of Life
  • Risk Assessment
  • Risk Factors
  • Stress, Psychological
  • Surveys and Questionnaires
  • Terminal Care
  • Time Factors
  • Treatment Outcome
  • United States

Research

keywords

  • Journal Article
  • Multicenter Study

Identity

Language

  • eng

PubMed Central ID

  • PMC4828728

Digital Object Identifier (DOI)

  • 10.1001/jamaoncol.2015.2378

PubMed ID

  • 26203912

Additional Document Info

start page

  • 778

end page

  • 784

volume

  • 1

number

  • 6