Posted with permission from The Moderate Voice

shutterstock_164491751From a really personal point of view this article jumped right out at me.

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.

As I said I have some personal experience here.  My uncle had cancer, lung cancer that had spread to his spine.  He had a rigorous chemotherapy regimen for the last few years of his life.  His quality of life continued to decline over that period.  When he finally died it was not from the cancer but from multiple organ failures which were the result of the chemotherapy.  His last few months were really a hell on earth.

But it's not just cancer.  My late father had severe cardiovascular disease. They were constantly cutting him open to correct various plumbing problems and after each surgery his quality of life was much less than it was before.  When he finally passed away he was a shadow of his original self.  One doctor finally had the nerve to say it was time to end the "heroic" efforts to keep him alive and I will be forever thankful.

My late mother was in pretty good physical shape for most of her life.  When they discovered she had a failing heart valve she was 86 years old and the cardiologist gave her a 50 – 50 chance of surviving the surgery to replace it.  Even if she had survived the surgery her quality of life would never be the same.  I made the decision to not have the surgery.  She lived to be 90 and except for the last few months when she was on home hospice her quality of life remained pretty good so I have never regretted that decision.  When she finally passed away it was in her own home and I was holding one of her hands and the wonderful caregiver I had hired to help me out was holding the other.

We all to some extent fear death, both our own and our loved ones but there are times when we have to say enough is enough and treatment becomes counter productive.  There is both the quantity of life and the quality of life we need to consider.

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