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Multicenter Study
. 2015 Sep;1(6):778-84.
doi: 10.1001/jamaoncol.2015.2378.

Chemotherapy Use, Performance Status, and Quality of Life at the End of Life

Holly G Prigerson  1 , Yuhua Bao  2 , Manish A Shah  3 , M Elizabeth Paulk  4 , Thomas W LeBlanc  5 , Bryan J Schneider  6 , Melissa M Garrido  7 , M Carrington Reid  8 , David A Berlin  9 , Kerin B Adelson  10 , Alfred I Neugut  11 , Paul K Maciejewski  12
Affiliations
Multicenter Study

Chemotherapy Use, Performance Status, and Quality of Life at the End of Life

Holly G Prigerson et al. JAMA Oncol. 2015 Sep.

Abstract

Importance: Although many patients with end-stage cancer are offered chemotherapy to improve quality of life (QOL), the association between chemotherapy and QOL amid progressive metastatic disease has not been well-studied. American Society for Clinical Oncology guidelines recommend palliative chemotherapy only for solid tumor patients with good performance status.

Objective: To evaluate the association between chemotherapy use and QOL near death (QOD) as a function of patients' performance status.

Design, setting, and participants: A multi-institutional, longitudinal cohort study of patients with end-stage cancer recruited between September 2002 and February 2008. Chemotherapy use (n = 158 [50.6%]) and Eastern Cooperative Oncology Group (ECOG) performance status were assessed at baseline (median = 3.8 months before death) and patients with progressive metastatic cancer (N = 312) following at least 1 chemotherapy regimen were followed prospectively until death at 6 outpatient oncology clinics in the United States.

Main outcomes and measures: Patient QOD was determined using validated caregiver ratings of patients' physical and mental distress in their final week.

Results: Chemotherapy use was not associated with patient survival controlling for clinical setting and patients' performance status. Among patients with good (ECOG score = 1) baseline performance status, chemotherapy use compared with nonuse was associated with worse QOD (odds ratio [OR], 0.35; 95% CI, 0.17-0.75; P = .01). Baseline chemotherapy use was not associated with QOD among patients with moderate (ECOG score = 2) baseline performance status (OR, 1.06; 95% CI, 0.51-2.21; P = .87) or poor (ECOG score = 3) baseline performance status (OR, 1.34; 95% CI, 0.46-3.89; P = .59).

Conclusions and relevance: Although palliative chemotherapy is used to improve QOL for patients with end-stage cancer, its use did not improve QOD for patients with moderate or poor performance status and worsened QOD for patients with good performance status. The QOD in patients with end-stage cancer is not improved, and can be harmed, by chemotherapy use near death, even in patients with good performance status.

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Figures

Figure
Figure. Patients’ Higher Quality of Life Near Death Stratified by Baseline Performance Status and Chemotherapy Use
ECOG indicates Eastern Cooperative Oncology Group. Performance status was measured by ECOG score as follows: 1, symptomatic, ambulatory; 2, symptomatic, in bed less than 50% of the time; and 3, symptomatic, in bed more than 50% of the time. Criteria used to evaluate higher quality of life near death are detailed in the Methods section.
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