COMMENTARY

Why Do Oncologists Give Chemo at the End of Life?

Paolo Bossi, MD

Disclosures

October 10, 2016

Editor's Note:
Despite the effort of major organizations, including the Institute of Medicine and the American Society of Clinical Oncology (ASCO), to put more emphasis on palliative care for cancer patients, data suggest that chemotherapy use in the last 2 weeks of life may actually be increasing in the United States.[1]

At ESMO 2016 in Copenhagen, Paolo Bossi, MD, a medical oncologist in the Head and Neck Cancer Department at the Fondazione IRCCS Istituto Nazionale dei Tumori in Milan, Italy, provided his perspective on a new study analyzing chemotherapy at the end of life on Medscape's ESMO 2016 Live Blog, which is excerpted below.

For a review of the most important ESMO 2016 sessions across all tumor types, visit Medscape's ESMO 2016 Live Blog.

The supportive and palliative care session at ESMO 2016 featured a very interesting study[2] presented by Philippe Rochigneux, MD, from the Institut Paoli-Calmettes Cancer Center in Marseille, France, on the use of chemotherapy near the end of life.

The study analyzed different factors associated with administering chemotherapy in the last months of life, such as young patient age, oncologist as treating physician, chemosensitivity of the tumor, and access to palliative care, among other factors.

The main analysis was performed with data from a national French hospital-based registry, including about 280,000 patients, that were used to calculate the rates of chemotherapy and targeted therapies in the last 3 months of life. Seventy percent of the patients were over 60 years of age; in 30% of the cases there was a palliative care unit in the facility.

The results deserve attention: About 40% of patients received chemotherapy in the last 3 months of life, 20% in the last month of life, and 11% in the last 2 weeks of life. About 7% of the patients started or resumed a therapy in the last month of life.

The following characteristics were associated with an increase in chemotherapy rates in the last month of life:

  • Patient-related factors, including male sex, young age, and fewer comorbidities;

  • Tumor location, specifically head and neck, lung, breast, and gynecologic cancers; and

  • Institutional factors, including higher overall volumes of chemotherapy given and private facilities.

During the abstract discussion, Stein Kaasa, MD, PhD, a professor of palliative medicine at the Institute of Cancer Research and Molecular Medicine at the Norwegian University of Science and Technology in Trondheim, asked what would be an ideal goal: 0% in the last month of life and 10% in the last 3 months?

This may be ideal, certainly, but what conclusions can be drawn from the current study?

Guidelines for oncologic care near the end of life are urgently needed, using prognostic scores to assess the possible benefit, or not, in choosing to continue (or to start) chemotherapy. Moreover, promoting end-of-life discussions with patients and caregivers is essential and should be started early in the course of patient care.

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