Fast Fact and Concept #014; Palliative Chemotherapy

2nd Edition

Author: David E. Weissman, MD

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 with locally advanced or metastatic cancer, chemotherapy is used with one of two intents: Hope for cure or hope for life-prolongation. Oncologists use the term palliative chemotherapy as a euphemism for chemotherapy that is not expected to be curative. What about chemotherapy used solely for symptom control—is that a realistic goal? Oncologists will occasionally 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, as a general rule, physical symptoms related to the cancer highly correlate with tumor burden; chemotherapy that does not effect tumor growth will generally not improve physical symptoms caused by the tumor.

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?

Response Rate = (# of complete responses + # of partial responses)/total # of treated patients; as studied in clinical trials. To qualify as a Response, the reduction in tumor must last for at least one month:

• Complete Response = complete eradication of measurable tumor;
• Partial Response = > 50% reduction in measurable tumor
• Progressive Disease = > 25% growth in measurable tumor.
• Stable Disease = anything between Partial response and Progressive Disease

Note : response rate data that is generally quoted to patients comes from clinical trials using good performance status who are closely monitored patients; the response rates for patients outside of clinical trials can be expected to be lower. (See Fast Fact # 99 Response and Survival data)

2. What is the Median Duration of Response of the proposed chemotherapy regimen? This number is vital for patients to make an informed decision and roughly correlates to months of added life to be expected if the chemotherapy is effective. The MDR, also known as Time to Progression (TTP), can be explained to the patient as: if the chemotherapy is effective at shrinking or stabilizing your cancer (if you are a chemotherapy responder), you can expect it will work for X-X months. (See Fast Fact # 99 Response and Survival data)

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? 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. For responding patients, chemotherapy is continued until there is disease progression or intolerable toxicities.

Reference

• Ellison N and Chevlin EM. Palliative Chemotherapy. In Principles and Practice of Palliative Care and Supportive Oncology . Berger A, Portenoy R and Weissman DE (eds). 2 nd Ed. Lippincott-Raven, 2002

Fast Facts were edited by David Weissman MD, Palliative Care Center, Medical College of Wisconsin until January 2007.  For comments/questions write to the current editor, Drew Rosielle MD: drosiell@mcw.edu. The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu

Copyright/Referencing Information : Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Weissman DE . Palliative Chemotherapy. Fast Fact and Concept #14; 2 nd Edition, July 2005. End-of-Life Palliative 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.

Purpose: Instructional Aid, Teaching

Audience(s)

ACGME Competencies: Medical Knowledge, Patient Care

Keyword(s): Cancer

Specific Disease and Organ System Category(s): Cancer