This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Save to my personal folders Download to citation manager Rights & Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Matsuyama, R. Articles by Smith, T. J. Search for Related Content PubMed PubMed Citation Articles by Matsuyama, R. Articles by Smith, T. J. Social Bookmarking                            What's this?

Why Do Patients Choose Chemotherapy Near the End of Life? A Review of the Perspective of Those Facing Death From Cancer

Robin Matsuyama, Sashidhar Reddy, Thomas J. Smith

From the Massey Cancer Center of Virginia Commonwealth University, Richmond, VA

Address reprint requests to Thomas J. Smith, MD, Virginia Commonwealth University, Division of Hematology/Oncology and Palliative Care, MCV Box 980230, Richmond, VA 23298-0230; e-mail: tsmith{at}hsc.vcu.edu

PURPOSE: The number of patients receiving chemotherapy near the end of life is increasing, as are concerns about goals of treatment, toxicity, and costs. We sought to determine the available sources of knowledge, the choices, and concerns of actual patients, and how patients balanced competing issues.

METHODS: We used a literature search from 1980 to present.

RESULTS: Available patient sources provide little information about prognosis, choices, alternatives, consequences, or how to choose. Many patients would choose chemotherapy for a small benefit in health outcomes, and for a smaller benefit than perceived by their health care providers for their own treatment. Adverse effects are less a concern for patients than for their well health care providers. There are no decision aids to assist patients with metastatic disease in making their choices, such as there are for adjuvant breast therapy.

CONCLUSION: The perspective of the patient is different from that of a well person. Patients are willing to undergo treatments that have small benefits with major toxicity. Receiving realistic information about the different options of care and the likelihood of successful treatment or adverse effects is difficult. These factors may explain some of the increased use of chemotherapy near the end of life. Decision aids and honest, unbiased sources to inform patients of their prognosis, choices, consequences, typical outcomes, and ways to make decisions are needed. More prospective information about how patients make their choices, and what they would consider a good choice, would assist informed decision making.

Authors' disclosures of potential conflicts of interest and author contributions are found at the end of this article.

CiteULike    Complore    Connotea    Del.icio.us    Digg    Facebook    Reddit    Technorati    Twitter    What's this?

This article has been cited by other articles:

				C. G. Azzoli, S. Baker Jr, S. Temin, W. Pao, T. Aliff, J. Brahmer, D. H. Johnson, J. L. Laskin, G. Masters, D. Milton, et al. American Society of Clinical Oncology Clinical Practice Guideline Update on Chemotherapy for Stage IV Non-Small-Cell Lung Cancer J. Clin. Oncol., December 20, 2009; 27(36): 6251 - 6266. [Abstract] [Full Text] [PDF]

				L. Mileshkin, P. E. Schofield, M. Jefford, E. Agalianos, M. Levine, A. Herschtal, J. Savulescu, J. A. Thomson, and J. R. Zalcberg To Tell or Not to Tell: The Community Wants to Know About Expensive Anticancer Drugs As a Potential Treatment Option J. Clin. Oncol., December 1, 2009; 27(34): 5830 - 5837. [Abstract] [Full Text] [PDF]

				T.-W. Liu, J.-S. Chen, H.-M. Wang, S.-C. Wu, Y.-N. Hung, and S. T. Tang Quality of End-of-Life Care Between Medical Oncologists and Other Physician Specialists for Taiwanese Cancer Decedents, 2001-2006 Oncologist, December 1, 2009; 14(12): 1232 - 1241. [Abstract] [Full Text] [PDF]

				S. T. Tang, S.-C. Wu, Y.-N. Hung, J.-S. Chen, E.-W. Huang, and T.-W. Liu Determinants of Aggressive End-of-Life Care for Taiwanese Cancer Decedents, 2001 to 2006 J. Clin. Oncol., September 20, 2009; 27(27): 4613 - 4618. [Abstract] [Full Text] [PDF]

				S. Kao, J. Shafiq, J. Vardy, and D. Adams Use of chemotherapy at end of life in oncology patients Ann. Onc., September 1, 2009; 20(9): 1555 - 1559. [Abstract] [Full Text] [PDF]

				E. Finlay and D. Casarett Making Difficult Discussions Easier: Using Prognosis to Facilitate Transitions to Hospice CA Cancer J Clin, July 1, 2009; 59(4): 250 - 263. [Abstract] [Full Text] [PDF]

				K. Hashimoto, K. Yonemori, N. Katsumata, M. Hotchi, T. Kouno, C. Shimizu, K. Tamura, M. Ando, M. Takeuchi, and Y. Fujiwara Factors That Affect the Duration of the Interval Between the Completion of Palliative Chemotherapy and Death Oncologist, July 1, 2009; 14(7): 752 - 759. [Abstract] [Full Text] [PDF]

				J. F. Wilson Cancer Care: A Microcosm of the Problems Facing All of Health Care Ann Intern Med, April 21, 2009; 150(8): 573 - 576. [Full Text] [PDF]

				L. C. Kaldjian, A. E. Curtis, L. A. Shinkunas, and K. T. Cannon Review Article: Goals of Care Toward the End of Life: A Structured Literature Review American Journal of Hospice and Palliative Medicine, January 1, 2009; 25(6): 501 - 511. [Abstract] [PDF]

				C. Storm, J. Casillas, H. Grunwald, D. S. Howard, K. McNiff, and M. M. Neuss Informed Consent for Chemotherapy: ASCO Member Resources J. Oncol. Pract, November 1, 2008; 4(6): 289 - 295. [Full Text] [PDF]

				J. McFarlane, J. Riggins, and T. J. Smith SPIKE$: A Six-Step Protocol for Delivering Bad News About the Cost of Medical Care J. Clin. Oncol., September 1, 2008; 26(25): 4200 - 4204. [Full Text] [PDF]

				C. C. Earle, M. B. Landrum, J. M. Souza, B. A. Neville, J. C. Weeks, and J. Z. Ayanian Aggressiveness of Cancer Care Near the End of Life: Is It a Quality-of-Care Issue? J. Clin. Oncol., August 10, 2008; 26(23): 3860 - 3866. [Abstract] [Full Text] [PDF]

				S. Audrey, J. Abel, J. M Blazeby, S. Falk, and R. Campbell What oncologists tell patients about survival benefits of palliative chemotherapy and implications for informed consent: qualitative study BMJ, July 31, 2008; 337(jul31_3): a752 - a752. [Abstract] [Full Text] [PDF]

				D. F Munday and E J. Maher Informed consent and palliative chemotherapy BMJ, July 31, 2008; 337(jul31_3): a868 - a868. [Full Text]

				M. S. McCabe and C. Storm When Doctors and Patients Disagree About Medical Futility J. Oncol. Pract, July 1, 2008; 4(4): 207 - 209. [Full Text] [PDF]

				S. E. Harrington and T. J. Smith The Role of Chemotherapy at the End of Life: "When Is Enough, Enough?" JAMA, June 11, 2008; 299(22): 2667 - 2678. [Abstract] [Full Text] [PDF]

				The Debate in Hospice Care J. Oncol. Pract, May 1, 2008; 4(3): 153 - 157. [Full Text] [PDF]

				J. A. Talcott Prostate Cancer Quality of Life: Beyond Initial Treatment and the Patient J. Clin. Oncol., September 20, 2007; 25(27): 4155 - 4156. [Full Text] [PDF]

				C. C. Earle Do Unto Others... J. Clin. Oncol., July 20, 2006; 24(21): 3331 - 3332. [Full Text] [PDF]