Can palliative treatment cure stage 4 cancer

Palliative cancer treatment: chemotherapy often does not improve quality of life

In some previous clinical studies, chemotherapy has prolonged life - albeit mostly short - and improved quality of life (QoL) in patients with end-stage metastatic carcinoma. An advantage is most likely expected with a comparatively good general condition (AZ). In a prospective study (1), patients with metastatic carcinomas, whose life expectancy the doctors estimated to be a maximum of 6 months, were determined at the start of the study (median 3.8 months before death) and asked whether palliative chemotherapy was taking place.

Shortly after death, the closest carers of the 312 patients (mean 58.6 years old) were asked about their QoL in the last week of life. Palliative chemotherapy was not associated with better QoL, contrary to what was expected, it was not associated with patients with good AZ (ECOG 0–1, corresponding to a Karnofsky index of ≥ 70%). On the one hand, the patients did not live longer than those with comparable ECOG values ​​who had not received chemotherapy; the risk of poorer quality of life was even higher with chemotherapy compared to patients without chemotherapy (odds ratio [OR] for deterioration in QoL: 0 , 35; 95% confidence interval [CI]: 0.17-0.75). In patients with ECOG 2, the OR was 1.06 (95% CI: 0.51–2.21) and for ECOG 3 the OR was 1.34 (95% CI: 0.46–3, 89). According to the authors, this tends to indicate better QoL due to chemotherapy with poorer AZ. Statistis

But the difference was not significant.

Conclusion: Patients and doctors often expect an improvement in quality of life from chemotherapy, even in the end-stage of cancer. In a prospective study, this expectation was not confirmed with moderate or poor AZ of cancer patients; with good AZ, chemotherapy shortly before death was even associated with poorer QoL.

In an editorial on the study (2) it is said that the result raises the “fundamental question” of whether chemotherapy makes sense at all given a life expectancy of a few weeks got involved in a “fight” with cancer, which they “could only lose for tumor biological reasons”. Rüdiger Meyer

  1. Prigerson HG, Bao Y, et al .: Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol 2015; DOI: 10.1001 / jamaoncol. 2015.2378
  2. Blanke CD, Fromme EK: Chemotherapy
    near the end of life. JAMA Oncol 2015; DOI: 10.1001 / jamaoncol. 2015.2378