TITLE:
Difficult Conversations and Painful Decisions: When Should Patients with Progressive Cancer Stop Chemotherapy?
AUTHORS:
Jeanine Staples, Varvara Mazina, Bethany-Rose Daubman, Annekathryn Goodman
KEYWORDS:
Chemotherapy, Chemotherapy Resistance, Chemotherapy Cessation, Palliative Chemotherapy, Recurrent Cancer and Prognosis, Best Supportive Care, Medical Futility, End-of-Life
JOURNAL NAME:
Journal of Cancer Therapy,
Vol.13 No.1,
January
24,
2022
ABSTRACT: Introduction: The decision to stop anti-cancer treatment is fraught with many
challenges for the oncologist, the patient, and their caregivers. This review
examines the special considerations surrounding the decision to cease
chemotherapy in terminally ill cancer patient. Methods: A comprehensive
literature search was conducted to find relevant publications on chemotherapy
cessation. A total of 2700 records were retrieved and 141 were identified as
eligible for inclusion in this review. Results: Palliative chemotherapy
does not achieve the goal of tumor-related symptom reduction for patients who
have experienced progressive disease with more than two prior lines of
chemotherapy. ECOG performance status is a crucial predictor of response to
therapy and chemotherapy-related complications. Challenges to stopping
chemotherapy at the end of life are multifactorial and are both patient and
physician-driven. Racial, ethnic, and income-based disparities are seen in the
timing and quality of end-of-life conversations offered by physicians to their
patients. Conclusions: The decision to cease chemotherapy is one that
should be approached with careful consideration and accurate information. Clear
communication, compassion and empathy are important components to the
therapeutic relationship. Early involvement of palliative care and clear
conversations about prognosis and the expected utility of further chemotherapy is
essential to conduct the best possible care for cancer patients at the end of life.