Chemotherapy Overused at End of Life, Study Finds

Many cancer patients with ailments unresponsive to chemotherapy are receiving the treatment near the end of their life anyway, a study of Massachusetts cancer patients has found. The New York Times reports that researchers examined state death certificates and Medicare billing records and determined that about one third of the 7,919 patients studied received chemotherapy in the "last six months of their lives." The research supports the view that oncologists are prescribing chemotherapy for "too many cancer patients" at the "terminal stages of the disease." Dr. Ezekiel Emanuel, chair of the department of clinical bioethics at the NIH and the senior author of the report, said the "strongly suggests overuse of chemotherapy at the end of life." He added that additional studies are needed to confirm the finding nationally and that such research could help "develop guidelines on when chemotherapy should be stopped in terminal cases." Currently, there are no guidelines for "appropriate" use of chemotherapy in end of life cases. Emanuel also called for studies on how managed care and fee-for-service practices "influenced" the use and timing of chemotherapy.

The Massachusetts study was one of several findings presented at a meeting of the American Society of Clinical Oncology. Other findings are noted below.

• Researchers at Brown University found that married women with malignant brain cancers are eight times more likely to "undergo separation or divorce" than men with the same condition.
  
• The "common notion" that depression and fatigue are linked to chemotherapy was downplayed in a study by researchers from the University of Rochester Cancer Center. The researchers found that Paxil could relieve depression, but not fatigue. Researchers concluded that fatigue is "more related" to the cancer and treatment rather than depression.
  
• Researchers at the Mayo Clinic in Rochester, Minn., found that dronabinol, a marketed derivative of marijuana, was less effective than the "standard treatment" of megestrol in stimulating appetite in cancer patients. In the study, 73% of patients on megestrol reported appetite improvement, compared to 47% of those taking dronabinol.
  
• For patients with cancer of the esophagus, a combination of chemotherapy and radiation can "spare removal of the voice box," a Johns Hopkins researcher found. Researchers at the Medical Research Council in London found that short doses of chemotherapy before surgery extended the life of these patients.
  
• A study of the experimental drug cetuximab found the treatment to be more effective than standard drugs for patients with colon cancer. Of the 121 patients who received the drug along with chemotherapy, colon cancers shrank about 50% or more in 23% of the patients.