Cancer Therapy at End of Life May Not Boost Survival

Patients with advanced solid cancers who received systemic therapy toward the end of life typically did not live any longer than patients who did not receive treatment, according to research published in JAMA Oncology.

Because cancer treatments can damper quality of life, it is crucial that patients and their loved ones discuss goals of care and prognosis with their oncology team, two experts emphasized.

“I think once we progress to advanced and metastatic cancer when cure is no longer feasible, it’s important to consider goals-of-care conversations,” said study author Maureen Canavan, associate research scientist at Yale School of Medicine.

Canavan and Dr. Kerin Adelson, also a study author, chief quality and value officer, and medical oncologist at The University of Texas MD Anderson Cancer Center in Houston, discussed the study findings in an interview with CURE®.

The researchers analyzed data from 78,446 patients treated across 144 different cancer treatment centers between the years 2015 and 2019. The cancers represented in the study were breast, colorectal, non-small cell lung, pancreatic, kidney and bladder.

After dividing health care practices based on how frequently they use systemic therapy (chemotherapy, targeted therapy or immunotherapy) during the last 14 days of patients’ lives, the researchers compared patient survival with institutions that were more or less likely to utilize these treatments near the end of life.

Ultimately, there was no significant difference in survival among the groups of institutions.

When to Have Goals-of-Care Conversations

While goals-of-care conversations should be happening throughout the entire cancer care continuum, Adelson mentioned that there may be some signs that a patient with advanced cancer may be facing the end of their life, such as worsening performance status.

MORE: End-of-Life Care Wishes Are Evolving Conversations for Patients, Caregivers

“To put this at a more [understandable] level, that would be more time spent in bed, more difficulty coming and going to appointments, a harder time caring for oneself in [tasks such as] shopping, bathing and [experiencing] increasing fatigue,” Adelson said. “[Signs also include] having likely gone through multiple therapies that are not working for very long anymore.”

Focus on Quality of Life

At this point, Adelson said that patients should talk to their care team about quality and quantity of life. They can discuss where they want to be toward the end of their life — in the hospital or at home — as well as what kind of pain management, emotional or physical needs they have.

These issues may be addressed through hospice (end-of-life) or palliative care. Of note, palliative care can be given at any point of cancer care, and focuses on improving quality of life. It can include aspects such as pain management, psychosocial and spiritual services.

Prior research has shown that increased cancer treatments at the end of life can negatively impact quality of life for both patients and their caregivers, Canavan explained.

“Pumping patients full of highly toxic chemotherapy when they have limited prognosis of survival is not something we want to do,” Canavan said.

“I think patients shouldn’t be afraid to ask questions,” Adelson said. “It’s very appropriate to have these conversations early to let their oncologists know what’s most important to them from the start of treatment when we are going to see survival benefits, so that relationship is focused around open and honest conversations, both about what the patient wants and what the oncologist believes will help.”

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