Chemotherapy near the end of life

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g1529 (Published 04 March 2014) Cite this as: BMJ 2014;348:g1529
  1. Michael W Rabow, professor of clinical medicine
  1. 1Department of Medicine, University of California, 1545 Divisadero Street, San Francisco, CA 94143-0320, USA
  1. mrabow{at}medicine.ucsf.edu

A difficult decision with potentially unexpected implications

Even as cancer treatments become more effective, we can still wonder about the symbolic meaning behind decisions to pursue chemotherapy near the end of life. Although most patients with metastatic cancer choose to receive palliative chemotherapy, evidence suggests that most do not clearly understand its intent.1 In decision making about chemotherapy, doctors are supposed to describe, and patients are supposed to understand, the direct outcomes of the proposed treatment (for example, clinical response rates and side effects). However, the broader implications of such decisions can be just as important. In the linked paper by Wright and colleagues (doi:10.1136/bmj.g1219),2 choosing palliative chemotherapy was associated with a whole set of outcomes that may not have been known, expected, or discussed by patients, their family caregivers, and their oncologists.

Wright and colleagues studied the outcomes of a cohort of 386 cancer patients who died during the Coping with Cancer Study, a federally funded cohort study of terminally ill cancer patients and their informal caregivers.3 Wright and colleagues’ participants were patients at eight US outpatient oncology clinics who had advanced cancer refractory to …

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