Monday, 8 June 2015

Palliative chemotherapy: an oxymoron?

An oxymoron is a figure of speech which consists in using contradictory terms in conjunction. In this case: chemotherapy and palliative care. From US data it’s well known that between 20 and 50% of patients with advanced cancer receive chemotherapy 30 days before death. I think these figures are impressive and even more so after reading the results of the work conducted by Professor Wright of Harvard Medical School. This is an ample view of over 386 patients with advanced cancer who averaged 4 months of life after entering the study. In this group it was noticed that patients who were treated with chemotherapy in the last months of life were more likely to receive towards the end of their life inappropriate clinical performances such as cardiac resuscitation or mechanical ventilation or to end their days in the intensive care units.

The American Society for Clinical Oncology (ASCO) believe that the disappearance of palliative chemotherapy would be a true "Triple Aim": better life quality for patients, fewer unwanted effects and lower costs, although the great difficulty with this issue, according to ASCO, lies in deciding when it’s time to stop treatment.

Note that in the video, Dr. Prigerson nails it when she says that when the forecast for life is less than the six months, oncologists are the ones who should learn to put things clearly. At this point there should be a key moment for planning the end, taking into account the peculiarities of each person but without any half-truths or half-open doors to nowhere. We must make it clear to the patient that at the end of life, palliative care, as opposed to chemotherapy, brings comfort and we ought to talk openly of where they prefer to spend their last days; this would facilitate decisions during the clinical process.

In short, when dealing with an advanced stage of cancer, one has to make a continuous assessment of the effectiveness of chemotherapy and when the  life expectancy is less than 6 months, the "conversation" that will encourage a turn towards palliative care and, therefore towards an end of life adapted to the patient's needs, should be taken into consideration.

Jordi Varela


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