Views & Reviews From the Frontline

Saying no to chemotherapy

BMJ 2013; 346 doi: (Published 21 June 2013) Cite this as: BMJ 2013;346:f4023

Re: Saying no to chemotherapy

As ever Des Spence is rightfully provocative in discussing the usefulness of palliative chemotherapy particularly when there is an unsustainable increase in the cost of anti-cancer medications. (1).

Cancer patients quite often want treatment, even if it is toxic, if it gives them a chance of prolonging life even by a few months. Cancer patients are much more willing to opt for intensive treatments with minimal chance of benefit than people who do not have cancer, including medical and nursing professionals.(2) (3).

Ethically, when a cancer patient, who has been counselled about all the advantages and disadvantages of chemotherapy, opts for chemotherapy, denying treatment is not an option.

Furthermore, symptoms caused by cancer pose the greatest threat to a cancer patient’s quality of life. Hence, if chemotherapy works, contrary to popular perception, a patient’s quality of life improves significantly with chemotherapy (as the work experience 16 year olds found out in my clinic over the last two weeks).

1. Spence D. Saying no to chemotherapy. BMJ 2013;346:f4023

2. Slevin ML, Stubbs L, Plant HJ, Wilson P, Gregory WM, Armes PJ, Downer SM. Attitudes to chemotherapy: comparing views of patients with cancer with those of doctors, nurses, and general public. BMJ. 1990 Jun 2;300(6737):1458-60.

3. Matsuyama R, Reddy S, Smith TJ. Why do patients choose chemotherapy near the end of life? A review of the perspective of those facing death from cancer.J Clin Oncol. 2006 Jul 20;24(21):3490-6

Competing interests: No competing interests

29 June 2013
Santhanam Sundar
Consultant Oncologist
Nottingham University Hospitals NHS trust
Nottingham. NG5 1PB