To Treat or Not to Treat Metastatic Cancer Patients with Poor Performance Status: a Prospective Experience.
Administration of cytotoxic chemotherapy for patients with metastatic cancer and poor performance status is a daily clinical challenge. Guidelines only help to select a therapeutic regimen but do not offer a clear response whether or not the patients should be treated. We performed a prospective analysis in 139 metastatic patients with performance status > 1 according to the Eastern Cooperative Oncology Group scale. A decision was considered correct if patients treated with a medical anticancer treatment lived over 3 months or alternatively patients not treated had a survival under 3 months. The predominant tumor type was non-small cell lung cancer. Patients were chemotherapy naive in 87 cases (63 %). A new line of medical anticancer treatment was started in 107 cases (77 %). The median survival of the study population was 11 weeks (range, 1-53). 84 patients (60 %) died within 3 months while 55 patients (40 %) lived more than 3 months after decision. Treatment decisions were considered as appropriate in 81 cases (58 %). No patient was considered as undertreated. The analysis by pathology allowed to identify pathologies where decisions were correct in the majority of the cases (renal, urothelial and small cell lung cancers), pathologies where appropriate and inappropriate decisions were balanced (prostate, ovarian and breast cancers) and pathologies where decisions for treatment were excessive (non-small cell lung cancer and unknown primary). This prospective study was conducted as part of the evaluation of professional practices in our department. Administration of a medical anticancer treatment validated with patients with good performance status may be harmful for patients with poor performance status. The findings resulted in recommendations for daily practice in order to help physicians, especially for the "don't go" decisions. Until the identification of new prognostic factors for survival and/or the development of therapies making sensitive currently chemoresistant diseases, the initiation of a medical anticancer treatment outside standard situations should result from a consensual decision team or the inclusion in a clinical trial.
Department of Medical Oncology, Hôpital Saint Louis, Paris, France. kullmanndoki@hotmail.com.|Department of Oncoradiology, Petz Aladár County Teaching Hospital, 9024, Győr, Vasvári Pál u. 2-4, Hungary. kullmanndoki@hotmail.com.
Tamás
T
Kullmann
Department of Medical Oncology, Hôpital Saint Louis, Paris, France.
Hélène
H
Gauthier
Department of Medical Oncology, Hôpital Saint Louis, Paris, France.
Camille
C
Serrate
Department of Medical Oncology, Hôpital Saint Louis, Paris, France.
Damien
D
Pouessel
Department of Medical Oncology, Hôpital Saint Louis, Paris, France.
Christine
C
le Maignan
Department of Medical Oncology, Hôpital Saint Louis, Paris, France.
Jean-Louis
JL
Misset
Department of Medical Oncology, Hôpital Saint Louis, Paris, France.
Stéphane
S
Culine
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000188:drug therapy* / Q000473:pathology*; D009369:Neoplasms / Q000188:drug therapy* / Q000473:pathology*; D011379:Prognosis; D011446:Prospective Studies
D000970:Antineoplastic Agents
Cytotoxic chemotherapy; Metastatic cancer; Performance status; Supportive care; Survival; Therapeutic decision