Fast Fact and Concept #14: Palliative Chemotherapy

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Title: Fast Fact and Concept #14: Palliative Chemotherapy

Author(s): Weissman, D.

This Fast Fact and Concept reviews the meaning of palliative chemotherapy and outlines information needed to determine the value of chemotherapy used for non-curative intent. This information can be used during rounds or as a handout for a teaching conference.

Educational Objective(s):
Review the meaning of the term palliative chemotherapy. Understand how to determine the risk/benefits of chemotherapy used for non-curative intent.
One often hears the term palliative chemotherapy, but what exactly does it mean and how can a non-oncologist decide if it has potential value?

Why is chemotherapy used?
From the perspective of the patient, chemotherapy is used with one of two intents: Hope for cure or Hope for life-prolongation. Oncologists generally use the term palliative chemotherapy when referring to treatment with a non-curative intent.

What about chemotherapy used solely for symptom control-is that a realistic goal?
Oncologists may recommend chemotherapy for symptom control, as there is some clinical trial data that in selected cancers chemotherapy may improve quality of life and/or symptom control without impacting survival. However, for the vast majority of patients, physical symptoms related to the cancer highly correlate with tumor burden; chemotherapy that does not effect tumor growth will not generally not improve physical symptoms caused by the tumor. Quality of life may be enhanced for some patients by chemotherapy, even when there is no anti-tumor effect, in large measure due to hope for a positive treatment effect.

What information do you need from the consulting oncologist to help a patient decide on the value of chemotherapy in advanced cancer?

1. What is the Response Rate of the proposed chemotherapy? The oncologic definition of response rate is: (# of complete responders + # of partial responders)/total # of treated patients. A partial response is >50% reduction in measurable tumor; a complete response is complete eradication of measurable tumor; the reduction in tumor must last for at least one-month to qualify as a response. Most clinical trials define progressive tumor when there is >25% growth in measurable tumor.

Note: In some slow growing cancers, stable disease resulting from chemotherapy can be very meaningful (<50% reduction, but < 25% growth).

Note: Response rate data quoted to patients comes from clinical trials using good performance status, highly monitored patients; in general, the response rates for patients outside of clinical trials can be expected to be lower.

2. What is the Median Duration of Response of the proposed chemotherapy regimen? This number is vital for patients to make an informed decision. Response ranges may be as short as 1-2 months for chemotherapy for pancreatic cancer to 9-12 months for 1st line breast cancer treatment.

3. What is the potential treatment burden? Acute and delayed toxicities, direct and indirect cost (lost work for family members), need for clinic visits or inpatient stays, need for treatment monitoring (e.g. blood tests, x-rays).

4. How long must treatment be continued to determine effect? Standard practice is to wait for two full cycles of treatment before assessing response; however, if a patient is progressing during the first cycle, they will almost always continue to progress through a second cycle.

Finally, patients always ask, "Will this treatment make me live longer?" In general, chemotherapy responders (partial or complete) live longer than non-responders-the duration of improved survival largely depends on the duration of response.

Also see:
Fast Fact #99: Chemotherapy: response and survival data

Reference: Ellison N. Palliative Chemotherapy. In Principles and Practice of Supportive Oncology. Berger A, Portenoy R and Weissman DE (eds). Lippincott-Raven, 1998

Fast Facts and Concepts are developed and distributed as part of the National Internal Medicine Residency End-of-Life Education project, funded by the Robert Wood Johnson Foundation.

Copyright Notice: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Weissman, D. Fast Fact and Concepts #14: Palliative Chemotherapy. June, 2000. End-of-Life Physician Education Resource Center www.eperc.mcw.edu.

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Creation Date: 5/2000

Format: Handouts

Purpose: Instructional Aid, Teaching

Training: Fellows, 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice
Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery
Non-Physician: Clergy/Chaplains, Patients/Families, Nurses, Social Workers

ACGME Competencies: Medical Knowledge, Patient Care

Keyword(s): Cancer, Radiation or chemotherapy

The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).