Sunday, March 16, 2014

Should I have chemotherapy?

Leave it to the journalists to create this obtuse title.
They should write: Palliative patient's receiving chemo end-of-life wished overlooked
The other mistake they make is to cite a US-study, with their vastly different procedures and billing methods, right to care protocols, leave some without care.

Some patients, declared palliative, receive palliative chemotherapy to "ease symptoms and prolong survival." Personally, my late mother was killed by chemotherapy, in her weak condition she could not tolerate it, nor could my late ex-husband, who had a heart attack and died. People with terminal illnesses need to have good information, counselling, and a supportive healthcare team who will tell them the truth and be honest about quality of life.

Patients declared palliative are entitled to know their disease trajectory, understand what their end-of-life might look like, and make the best decisions for themselves and their families.
For example, patients with ALS often receive excellent support from the ALS Society, and understand about their trajectory, and often complete DNR orders.

All patients need to understand about therapies, treatment outcomes, the impact of tube feeding, and other treatments that can reduce their quality of life.

What this study concluded is that:
  • 47% of the palliative chemotherapy group died at home
  • 68% of patients treated with palliative chemotherapy died where they wanted to die.
  • 80% of all patients without palliative chemotherapy died in a location of their choice (Home, hospice, hospital).

  • Terminal patients receiving chemotherapy less likely to die at home
    A team of researchers from Harvard Medical School, the Weill Cornell Medical College and the Dana-Farber Cancer Institute.  The study, published in BMJ (formerly the British Medical Journal), followed 386 adult patients of varying ages from eight oncology clinics across the U.S. for a period of six years, from 2002 to 2008.
    “Until now, there hasn’t been evidence of harmful effects of palliative chemotherapy in the last few months of life,” said the study’s senior author Dr. Holly Prigerson. “This study is a first step in providing evidence that specifically demonstrates what negative outcomes may result.”

    No comments: