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- Holly G Prigerson, Yuhua Bao, Manish A Shah, M Elizabeth Paulk, Thomas W LeBlanc, Bryan J Schneider, Melissa M Garrido, M Carrington Reid, David A Berlin, Kerin B Adelson, Alfred I Neugut, and Paul K Maciejewski.
- 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.
- JAMA Oncol. 2015 Sep 1; 1 (6): 778-84.
ImportanceAlthough 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.ObjectiveTo evaluate the association between chemotherapy use and QOL near death (QOD) as a function of patients' performance status.Design, Setting, And ParticipantsA 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 MeasuresPatient QOD was determined using validated caregiver ratings of patients' physical and mental distress in their final week.ResultsChemotherapy 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 RelevanceAlthough 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.
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