title: Limited impact of palliative chemotherapy on survival in advanced solid tumours in patients with poor performance status.
abstract: OBJECTIVE
  Oncologists should carefully weigh up the risks and benefits of palliative chemotherapy in patients with advanced solid tumours (AST) and poor general status from the standpoint both of medical and ethical issues and of healthcare resources required. This study is intended to assess the impact on overall survival of palliative chemotherapy in patients with AST and admitted to hospital as a result of their poor ECOG status.
  
  
  METHODS
  We performed a retrospective analysis of 92 hospitalised patients with AST, ECOG 3-4, who were treated with palliative chemotherapy. Uni- and multivariate statistical analyses were conducted to determine the impact of clinical and disease variables (number of previous chemotherapy lines, presence of comorbidities, presentation of anorexia-cachexia syndrome, delirium, dyspnoea, ascitis, brain metastases, T-cell count, albumin, haemoglobin and LDH) on survival in this patient population.
  
  
  RESULTS
  Mean age was 54 years (range 15-80). No chemotherapy had been given for advanced disease in 74%, 13% had received one line, 6% 2 lines and 7% ≥3 lines. Median survival, i.e., after initiation of chemotherapy to death, in these patients was 33 days (range 1-1390). The median of chemotherapy cycles was 1. In the multivariate analysis, no previous chemotherapy, and absence of anorexia-cachexia syndrome and of comorbidities was associated with significantly improved survival in patients. Forty-nine percent of patients died within 30 days of therapy, 28% died between days 30 and 90, and only 23% of patients lived longer than 90 days. Grade 3-4 toxicities mainly entailed blood disorders, namely anaemia 8%, neutropenia 13% and thrombocytopenia 8%. Six patients (5%) developed sepsis after therapy; of these, 3 died from this toxicity, 1 patient suffered cardiac toxicity, one patient leukoencephalopathy and 1 patient acute pulmonary thromboembolism.
  
  
  CONCLUSIONS
  Palliative chemotherapy given to patients with AST and ECOG 3-4 with short life expectancy provided no benefit for survival. As a result, we may be over-treating these patients and contributing to poor-quality care.
authors.affiliation: Medical Oncology Department, Hospital Universitario Virgen de la Victoria, Málaga, Spain. asmoncomed@yahoo.es
authors.forename: Alfonso
authors.initials: A
authors.lastname: Sánchez-Muñoz
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Pérez-Ruiz
authors.forename: María Isabel
authors.initials: MI
authors.lastname: Sáez
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Trigo
authors.forename: M Mar
authors.initials: MM
authors.lastname: Galindo
authors.forename: Lourdes
authors.initials: L
authors.lastname: Manzaneque
authors.forename: Begoña
authors.initials: B
authors.lastname: Jiménez
authors.forename: Begoña
authors.initials: B
authors.lastname: Muros
authors.forename: Emilio
authors.initials: E
authors.lastname: Alba
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D010166:Palliative Care; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult