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The end-of-life discussion that has nothing to do with costs

The question about how much care to give a dying person in their last moments is one of the most contentious issues in medicine, instantly raising worries that any decision to not give a person treatment might be about saving money.

A new study finds that, at least in cancer, there’s a very real medical reason to consider giving less treatment at the end of life: Chemotherapy doesn’t improve dying patients’ quality of life. In fact, for those terminal cancer patients who were doing the best at the beginning of the study and were least disabled by their cancer, receiving chemotherapy was associated with worse quality of life near death.

“For oncologists, the default seems to be if a patient can tolerate another chemotherapy regimen. There’s a perception or the conventional wisdom is there is no harm in trying,” said Holly Prigerson, director of the Center for Research on End-of-Life Care at Weill Cornell Medical College. “The power of this analysis is it’s one of the first, I believe, to demonstrate there are harms.”

The study, published in JAMA Oncology, examined the cases of 312 people with progressive cancers that had spread and followed them until their deaths. The chemotherapy administered at this stage was palliative, and the study did not find any difference in survival.

In an accompanying editorial, two physicians from the Oregon Health and Science University wrote that there are only two reasons to give a patient chemotherapy, which can be time-consuming, expensive and have side effects: it should either extend their lives or make their lives better.



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