Chemotherapy Use, Performance Status, and Quality of Life at the End of Life.

TitleChemotherapy Use, Performance Status, and Quality of Life at the End of Life.
Publication TypeJournal Article
Year of Publication2015
AuthorsPrigerson HG, Bao Y, Shah MA, M Paulk E, LeBlanc TW, Schneider BJ, Garrido MM, M Reid C, Berlin DA, Adelson KB, Neugut AI, Maciejewski PK
JournalJAMA Oncol
Date Published2015 Sep
KeywordsAdult, Aged, Antineoplastic Agents, Chi-Square Distribution, Female, Health Status, Health Status Indicators, Humans, Logistic Models, Longitudinal Studies, Male, Middle Aged, Multivariate Analysis, Neoplasm Metastasis, Neoplasm Staging, Neoplasms, Odds Ratio, Palliative Care, Patient Selection, Proportional Hazards Models, Prospective Studies, Quality of Life, Risk Assessment, Risk Factors, Stress, Psychological, Surveys and Questionnaires, Terminal Care, Time Factors, Treatment Outcome, United States

IMPORTANCE: 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.

DESIGN, SETTING, AND PARTICIPANTS: 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.

MAIN OUTCOMES AND MEASURES: 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 AND RELEVANCE: 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.

Alternate JournalJAMA Oncol
PubMed ID26203912
PubMed Central IDPMC4828728
Grant ListCA106370 / CA / NCI NIH HHS / United States
CDP 12-255 / HX / HSRD VA / United States
MD007652 / MD / NIMHD NIH HHS / United States
R01 MD007652 / MD / NIMHD NIH HHS / United States
MH63892 / MH / NIMH NIH HHS / United States
R01 CA106370 / CA / NCI NIH HHS / United States
P30 AG022845 / AG / NIA NIH HHS / United States
IK2 HX000767 / HX / HSRD VA / United States
R01 MH063892 / MH / NIMH NIH HHS / United States
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