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It's hard to swallow to learn that your cancer is terminally ill.
In addition, new research indicates that, when they have only one month to live, a significant number of patients still opt for aggressive and often costly interventions, despite the limited evidence suggesting they will help.
A unique population
In the United States, a study involving just over 100,000 patients revealed that the ultimate need for unsuccessful cancer treatment "is not a rare phenomenon," said Dr. Helmneh Sineshaw, author of Study, from the American Cancer Society.
More than a quarter of patients have undergone active treatment, such as a surgical operation or chemotherapy, in the last weeks of their life, said Sineshaw, director of treatment regimens and outcome research for the cancer society.
"Patients newly diagnosed with metastatic cancer and who die soon after diagnosis are a unique population," he said. The findings suggest a need to better identify people who would be better off with palliative care – aimed at relieving symptoms and stress – rather than aggressive and costly treatments.
Dr. Richard Schilsky, Chief Medical Officer of the American Society of Clinical Oncology, acknowledged that this group is "quite rare" and accounts for only 5% of cancer cases.
"It's a difficult scenario for doctors and patients," added Schilsky. "But oncologists have an obligation to better inform their patients about the prognosis, treatment goals and expectations in terms of the benefits and side effects of any treatment plan. "
Decisions vary considerably
For those affected, care planning can be very "complex," Sineshaw said. Decisions imply a delicate interaction between doctors, patients and relatives, he explained.
"While there are some guidelines for streamlining the decision-making process, a more concerted effort is needed to improve the quality of care provided to these patients," he said.
For the study, the Sineshaw team reviewed data from the US National Cancer Database for adult patients with lung, bad, pancreatic and / or advanced colon cancer. (metastatic) was diagnosed between 2004 and 2014.
The badysis confirmed that most – about 73% – do not undergo active treatment during their last month of life.
But many do, although decisions vary greatly depending on the type of cancer involved.
For example, less than 1% of patients with advanced pancreatic cancer have been operated on, compared to more than 28% of patients with colon cancer.
How to avoid unnecessary therapies
And while less than 6% of patients with terminal colon cancer had opted for chemotherapy, 11% of patients with lung and bad cancer did so.
Similarly, just over 1% of patients with pancreatic cancer have chosen radiation therapy in recent weeks, compared with nearly 19% of lung cancer patients (who accounted for approximately two-thirds of patients in the study).
Aggressive treatments were more common among younger patients, those who had no other chronic illness besides cancer, and those who had private insurance, said Sineshaw.
Investigators have observed that the place where a person is being treated is also important. For example, lung cancer patients who received care at centers designated by the National Cancer Institute were 48% more likely to be irradiated in their last month of life than patients treated at a cancer center Community.
In the end, the research team concluded that further research was needed to determine why so many patients were receiving ineffective treatment and to learn to "avoid unnecessary, aggressive and costly treatments."
No evidence suggesting a benefit
Schilsky pointed out that "sometimes, treatment directed against cancer, especially radiation therapy, is a necessary and important part of palliative care because it can effectively relieve pain, obstruct or minimize serious bleeding."
But he acknowledged that some patients might not be able to follow the advice of an expert who would advise them not to be treated if there was any evidence suggesting a benefit.
"It is understandable that some patients have difficulty accepting such recommendations and advice from hospice, clergy or mental health professionals," Schilsky said.
The results were published online in the journal JNCI Cancer Spectrum.
Image credit: iStock
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