Journal of Clinical Oncology, Vol 24, No 21 (July 20), 2006: pp. 3490-3496
© 2006 American Society of Clinical Oncology.
DOI: 10.1200/JCO.2005.03.6236
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.
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