Rarely, but sometimes, a medical intervention is not just qualitatively or quantitative futile but actually physiologically futile. In the latest issue of BMC Palliative Care, Akiko M Saito and colleagues found:
About one tenth (8.5%) of patients who had ever received chemotherapy were still receiving chemotherapy within 14 days of death; this population experienced no survival benefit as determined by three different statistical approaches. These patients were also much less likely to receive hospice care or and more likely to receive it for three or fewer days. These results suggest that patients receiving chemotherapy within 14 days of death do not benefit from this aggressive approach to treatment, and they may also be deprived of good palliative care provided by hospice.
The authors conclude:
We could not detect a benefit in survival from continuing chemotherapy close to death. Furthermore, this treatment was associated with substantially reduced use of palliative hospice care. The Health Services Research Committee of the American Society of Clinical Oncology (ASCO) agreed that treatment could still be recommended, even without an improvement in survival, if it improves the quality of life in the case of metastatic cancer. Our data suggest that an aggressive approach to continuing chemotherapy to very near death likely does not meet this test in that it may result in no survival benefit, and, in fact, in negative outcomes. It is imperative that physicians present honest, individualized, evidence-based information to patients making treatment decisions near the end of life about the expected risks and benefits of chemotherapy.
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