title: To treat or not to treat cancer patients with chemotherapy at the end of life?
abstract: An interesting prospective British study examined clinical and laboratory data from about 600 patients who died within 30 days of receiving cytotoxic cancer chemotherapy. The vast majority of patients had been treated with palliative rather than curative intent. For about one-quarter of the patients who received palliative chemotherapy, the therapy was considered to have caused or hastened their death. 40% of the patients who died within 30 days following chemotherapy had experienced a serious adverse effect related to the cytotoxic treatment, sometimes requiring hospitalisation. These adverse effects included infections, coagulation disorders, gastrointestinal disorders and renal impairment. Nearly one-quarter of the patients had a poor performance status when chemotherapy was instituted. In particular, more than half of them already had a cancer-related complication when they started the cycle, such as impaired kidney or liver function, hypoalbuminaemia, ascites or pleural effusion. Only 16% of the deaths were discussed with the medical team in a morbidity and mortality meeting. In practice, not administering cytotoxic chemotherapy is sometimes the best solution for patients. Healthcare teams would be well advised to prepare for the (ideally shared) decision on whether or not to treat a terminally ill cancer patient with cytotoxic drugs; by conducting a systematic analysis of the causes of death of other patients treated in the same manner.
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D002423:Cause of Death; D006801:Humans; D009369:Neoplasms / Q000188:drug therapy* / Q000503:physiopathology; D010166:Palliative Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents