Education And Debate

Chemotherapy for cancer patients who present late

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7453.1430 (Published 10 June 2004) Cite this as: BMJ 2004;328:1430
  1. Stella J Bowcock, consultant haematologist ([email protected])1,
  2. Charles D Shee, consultant physician in respiratory and palliative medicine1,
  3. Saad M B Rassam, consultant haematologist1,
  4. Peter G Harper, consultant medical oncologist2
  1. 1Queen Mary's Sidcup NHS Trust, Sidcup, Kent DA14 6LT
  2. 2Department of Medical Oncology, Guy's and St Thomas's Hospital NHS Trust, London SE1 9RT
  1. Correspondence to: S J Bowcock
  • Accepted 1 October 1993

Doctors should not overlook the potential benefits of chemotherapy in patients with incurable cancer

A patient presenting with an advanced curable cancer is usually regarded as a medical emergency and treated with chemotherapy and full medical support. However, a patient presenting with a chemosensitive but incurable cancer at an advanced stage may be offered only palliative care. We argue that giving reduced dose chemotherapy to very ill patients with incurable cancer can be beneficial. The benefits can include symptom control and buying a short window of time to allow the patient and family to come to terms with the diagnosis. The cancer patients we are discussing are those who are newly diagnosed with chemosensitive tumours and who have not had previous chemotherapy. They must be distinguished from previously treated cancer patients, who may be resistant to chemotherapy and in whom supportive palliative measures may be more appropriate.

Survival of patients with poor performance status

Trials in most malignancies show that poor performance status correlates closely with reduced survival1 2 and in some cases reduced response rate to chemotherapy.1 2 It is therefore easy to assume that patients presenting at an advanced stage with a poor performance status secondary to high tumour burden would gain little from chemotherapy. In the 1980s and early 1990s the trend was to increase the dose of chemotherapy in order to maximise response rates in cancers.1 This led to increased toxicity in very ill patients and was especially unacceptable if the goal was palliation rather than cure. It is therefore not surprising that articles discouraged the use of chemotherapy in late presenting patients with poor performance status.1

Eastern Cooperative Group/World Health Organization performance status scale

0 = Normal activity, no restrictions

1 = Restricted but ambulatory; able to carry out light work

2 = Ambulatory and self caring but unable to carry out light work; up more …

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