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Is Chemo appropriate for late stage cancer? New Research

Today I want to share an article by Dr Ian Gawler.  I am often frustrated when Oncologists who give late stage cancer patients chemo.  Only to find that the side effects make them so ill they end up passing in hospital rather than  dying at home.  One of my clients I am working with is in his 70″s. He has been offered chemo however we are working with food, proper vitamins and minerals  ,  exercise, meditation and his ” happy list”.   All of this means he is feeling better and there is no advancement in his cancer.   In  the article below Ian Gawler from his blog Out on a LImb presents the latest scientific research on Chemotherapy and late stage patients.

“It is hard to say how often I have heard this, but it is very common. “We could try some chemotherapy…. “

Patients with end-stage cancer often receive chemotherapy, under the assumption that it will improve their quality of life or may even extend survival. However, 2 new major pieces of research have found quite the opposite – quality of life was worse with no benefit to overall survival.

For years it has been disturbing to watch as people in reasonable health but with advanced cancer were doing OK, only to be offered chemo. Often the statement was “You are doing so well now, why don’t we try some chemo”.

Understandably, it is extremely difficult for many people to resist this offer. Commonly it comes with big pressure from family and friends who, according to experience that is backed up by research, are like many patients and mistakenly believe the chemo will extend life as well as improve quality of life.

However, the American Society for Clinical Oncology recently identified end of life chemotherapy as one of the “top five” practices that could improve patients’ care and reduce costs, if stopped. This is confirmed by these two important research findings which themselves confirm earlier research.

The first, in the British Medical Journal concluded chemotherapy given to terminally ill cancer patients months before death was associated with no improvement in survival times, higher levels of intensive medical care (cardiopulmonary resuscitation, mechanical ventilation, or both) in the last week of life, higher probability of dying in an intensive care unit and less chance of dying in preferred place of death, like at home.

This is something we need to know of well in advance, because in the heat of the moment – at the end of life, people often opt for chemo and suffer unnecessarily.

Not to say chemo is not useful at other times, but there is a need to be very selective late in life.
In fact, the statistics show most chemo is given palliatively.

The lead researcher Dr. Prigerson believes that the use of chemotherapy at the end of life, and conversation about it, needs reforming. “The term palliative chemotherapy is disingenuous,” she told Medscape Medical News in an interview. “There is a negative side to chemotherapy; it makes you sicker.”

The second piece of research just published in JAMA Oncology adds more vital information. Lead author Prof. Holly G. Prigerson from Cornell said “If this so-called palliative chemotherapy is given to improve their symptoms, then these data should give them pause that it’s not going to help.”

Of particular significance, these findings indicate that patients with good performance status (this is medical speak for being reasonably well) were the ones most likely to receive chemotherapy near the end of life, she said in an interview.

“In our study, 100% of the patients who were feeling well and asymptomatic were being given chemotherapy,” Dr Prigerson explained. “So the question is, why? Why would a person who was functioning well be given chemotherapy?”

Charles D. Blanke, MD, and Erik. K. Fromme, MD, suggest “If an oncologist suspects the death of a patient in the next 6 months, the default should be no active treatment. Let us help patients with metastatic cancer make good decisions. Let us not contribute to the suffering that cancer, and often associated therapy, brings, particularly at the end.”

For years I have seen people adversely affected by this and now it seems a much needed correction may be coming…

I first wrote of this in 2006 when research began to emerge that reflected what was being observed amongst people in our groups (one short article and one longer, highly referenced one that was used as a basis for presenting at 2 major medical conferences that same year. They are on my website in the Information section and are still relevant – links below).

People who were managing their situation well with lifestyle therapies – good nutrition, positive thinking, meditation, working on their emotional health, relationships and state of mind, were being told they were doing much better than expected, so “Why don’t we try some chemo now? Do you want it?” Hard to resist in the climate we live in.

But then people would often be overrun by the side-effects. Eating well became problematic, meditation harder, state of mind affected, harder to be positive. And one medical intervention commonly led to another, often leading to tough last days.

So please share this information. While it may not be what some would like to hear, and maybe it is not a popular topic for conversation, it distresses me deeply to observe how often people who are managing advanced cancer well go into chemotherapy, only to be wiped out by it and die in difficult circumstances.

By contrast, there have been many people who have managed symptoms really well and died well, having carried through with the lifestyle approach and finding the stability and comfort that comes with consistent meditation.

Of course it would be wonderful if everyone survived cancer. But is highly possible to die well from it, in good circumstances, feeling that life has been completed. When this happens it makes it so much easier and better for family and friends as well.

Please share  ….

Wright A A et al, Associations between palliative chemotherapy and adult cancer patients’ end of life care and place of death: prospective cohort study, BMJ 2014;348:g1219

Prigerson HD et al, Chemotherapy Use, Performance Status, and Quality of Life at the End of Life, JAMA Oncol. Published online July 23, 2015. doi:10.1001/jamaoncol.2015.2378

Chemotherapy: how much does it contribute to 5 year survival?  

Cancer, lifestyle and chemotherapy: A documented examination of the benefits and side effects of lifestyle factors and chemotherapy.

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