With Weeks to Live, Many Cancer Patients Try Useless Treatments

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TUESDAY, April 16, 2019 (HealthDay News) -- Learning you have a cancer that looks imminently terminal is tough news to swallow.

And new research indicates that when given just one month to live, a significant number of patients still opt for aggressive and often costly interventions, despite little evidence to suggest they'll help.

A study of just over 100,000 patients in the United States found that the urge to undergo ultimately fruitless cancer treatment "is not a rare phenomenon," said study author Dr. Helmneh Sineshaw, of the American Cancer Society.

More than one-quarter underwent active treatment, such as surgery or chemotherapy, in the final weeks of life, said Sineshaw, director of treatment patterns and outcomes research for the cancer society.

"Patients newly diagnosed with metastatic cancer who die soon after diagnosis are a unique population," he said. The findings suggest a need to better identify people who would fare better with palliative care -- aimed at symptom and stress relief -- rather than aggressive and expensive treatments.

Dr. Richard Schilsky, chief medical officer for the American Society of Clinical Oncology, agreed that this group is "pretty rare," accounting for just 5 percent of cancer cases.

"This is a challenging scenario for doctors and patients," Schilsky added. "But oncologists have an obligation to inform their patients as best as they can about the prognosis, the goals of treatment, and the expectations for benefit and side effects from any treatment plan."

For those affected, care planning can be very "complex," said Sineshaw. Decisions involve a tricky interplay of doctors, patients and loved ones, he explained.

"Although there are some guidelines to streamline the decision-making process, a more concerted effort is needed to improve quality of care for these patients," he said.

For the study, Sineshaw's team reviewed data from the U.S. National Cancer Data Base on adult patients newly diagnosed with advanced (metastatic) lung, breast, pancreatic and/or colon cancer between 2004 and 2014.

The analysis confirmed that most --about 73 percent -- do not undergo active treatment during their last month of life.

But many do, although decisions vary widely, depending on the type of cancer involved.

For example, less than 1 percent of advanced pancreatic cancer patients underwent surgery versus more than 28 percent of colon cancer patients.

And while less than 6 percent of the terminal colon cancer patients opted for chemotherapy, 11 percent of lung and breast cancer patients did so.

Similarly, just over 1 percent of the pancreatic cancer patients chose radiation in their final weeks compared to nearly 19 percent of lung cancer patients (who accounted for about two-thirds of the study patients).

Aggressive treatment was more common among younger patients, those with no other chronic illness apart from cancer, and those with private insurance, said Sineshaw.

Investigators observed that where someone is treated also matters. For example, lung cancer patients who received care at National Cancer Institute-designated centers were 48 percent more likely to undergo radiation their last month of life compared with patients treated at a community cancer center.

Ultimately, the research team concluded that more research is needed to determine why so many patients receive ineffective treatment and to learn how to "avoid unnecessary aggressive and expensive therapies" going forward.

Schilsky emphasized that "sometimes cancer directed-treatment, particularly radiation therapy, is a necessary and important part of palliative care as it can effectively relieve pain, obstruction or minimize severe bleeding."

But he acknowledged that some patients may not be able to take in expert guidance recommending against treatment when there is no evidence to suggest a benefit.

"It is understandable that some patients will have trouble accepting that such recommendations and counseling by hospice, clergy or mental health professionals can be of value," Schilsky said.

The findings were published online April 15 in the journal JNCI Cancer Spectrum.

More information

To learn more about questionable cancer treatments, visit the ABIM Foundation.

SOURCES: Helmneh Sineshaw, M.D., M.P.H., director, treatment patterns and outcomes research, American Cancer Society, Atlanta; Richard Schilsky, M.D., senior vice president and chief medical officer, American Society of Clinical Oncology; April 15, 2019, JNCI Cancer Spectrum, online

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Thu Apr 18, 2019 08:12 PM

It's very understandable when you get the worts possible news man can get, that you are willing to do everything in your power to continue living. It's only human to offer any care that MIGHT help and lack of humanity to forbid it.

Thu Apr 18, 2019 08:17 PM

It's very understandable when you get the worts possible news man can get, that you are willing to do everything in your power to continue living. It's only human to offer any care that MIGHT help and lack of humanity to forbid it.

Thu Apr 18, 2019 09:50 PM

Reflecting back upon our last year with my wife with pancreatic cancer, I wonder it was the right choice.

She could "live" 10 months, and accurate prognosis; but I question the definition of "live". While she "survived" those ten months, she did not "live" those ten months, she merely survived that long. 

Wed - Go to the hospital for lab tests, in preparation for properly mixing the chemo.

Thur - All day at the cancer centre receiving chemo

Fri, Sat - Dozing off throughout the those two days due to the chemo.

After the chemo et al, that reduced actual "living" to a mere three days a week!  :-(

I knew a doctor who "lasted" 40 months with the same disease. She avavailed herself of everything modern medicine had to offer: multiple surgeries, chemo, radiation etc. But she did not "live" those 40 months, she only "existed" in life of total hell!
These are difficult decisions for those of us who are faced with them. The correct answer though remains elusive. :-(     

Fri Apr 26, 2019 07:12 PM

Life is all and everything we have. I am a stageIV gliosarcoma patient given 2-3 months to live 2 and a half years ago and living through the negative consequences of chemo and radiation I stepped away from it all to simply live my life better. Life is beautiful and I face the adversity with a simple mindset of enjoy today and believe in tomorrow.

I have no answers but will say belief and positivity is powerful in fighting adversity. 

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