title: Chemotherapy Use, Performance Status, and Quality of Life at the End of Life.
abstract: OBJECTIVE
  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.
  
  
  OBJECTIVE
  To evaluate the association between chemotherapy use and QOL near death (QOD) as a function of patients' performance status.
  
  
  METHODS
  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.
  
  
  METHODS
  Patient QOD was determined using validated caregiver ratings of patients' physical and mental distress in their final week.
  
  
  RESULTS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York2Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
authors.affiliation: Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York.
authors.forename: Yuhua
authors.initials: Y
authors.lastname: Bao
authors.affiliation: Meyer Cancer Center of Weill Cornell Medical College, Medical Oncology/Solid Tumor Program, New York, New York.
authors.forename: Manish A
authors.initials: MA
authors.lastname: Shah
authors.affiliation: Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas.
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Paulk
authors.affiliation: Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: LeBlanc
authors.affiliation: University of Michigan Comprehensive Cancer Center, Ann Arbor.
authors.forename: Bryan J
authors.initials: BJ
authors.lastname: Schneider
authors.affiliation: James J. Peters VA Medical Center, Bronx, New York9Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York.
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Garrido
authors.affiliation: Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: M Carrington
authors.initials: MC
authors.lastname: Reid
authors.affiliation: Department of Medicine, Medical Intensive Care Unit, New York Presbyterian Hospital-Weill Cornell Center, New York.
authors.forename: David A
authors.initials: DA
authors.lastname: Berlin
authors.affiliation: Smilow Cancer Hospital at Yale-New Haven, Yale University School of Medicine, New Haven, Connecticut.
authors.forename: Kerin B
authors.initials: KB
authors.lastname: Adelson
authors.affiliation: Department of Medicine and Herbert Irving Comprehensive Cancer Center, College of Physicians and Surgeons, Columbia University, New York, New York12Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
authors.forename: Alfred I
authors.initials: AI
authors.lastname: Neugut
authors.affiliation: Center for Research on End-of-Life Care, Weill Cornell Medical College, New York, New York14Department of Radiology, Weill Cornell Medical College, New York, New York.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Maciejewski
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D005260:Female; D006304:Health Status; D006305:Health Status Indicators; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D009369:Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000523:psychology; D016017:Odds Ratio; D010166:Palliative Care / Q000379:methods*; D018579:Patient Selection; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011788:Quality of Life; D018570:Risk Assessment; D012307:Risk Factors; D013315:Stress, Psychological / Q000523:psychology; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000970:Antineoplastic Agents