When cancer is considered incurable, the focus shifts from cure to extending life and promoting comfort. Palliative chemotherapy is the use of anti-cancer drugs to prolong life and often improve the symptoms of cancer.
When considering if palliative chemotherapy is right for you, it’s important to ask your oncologist five questions:
- How effective is this particular chemotherapy at reducing tumor size?
You will want to know the response rate of the chemotherapy your oncologist is proposing. Response rates refer to the number of people whose tumors will either shrink or disappear as a result of the drug or drugs given. Response rates are established through research. For example, a certain type and stage of cancer might have a 70% response rate to a certain combination of drugs. This means that 70% of the people with this type and stage of tumor have a response to this combination of drugs. It also means that 30% of the people with this type and stage of cancer will not respond to the treatment or will have only a minimal response.
- How long and how many cycles of chemotherapy will it take before we know its working?
You will want to know what you’re in for and how long you're in it. Chemotherapy regimens can vary a great deal. Some cancers are treated in as little as 1 to 2 months while others may be treated for a full year. It’s standard to try two full cycles of chemotherapy before deciding whether it’s working or not.
- What are the potential burdens of treatment?
Chemotherapy can have some highly undesirable side effects. We all know about the possibility of nausea or upset stomach, loss of hair, and weight loss, but there are other potentially serious effects and you will want to know if you’re at risk for developing them. You will also want to know what the personal burden will be on you and your family. How often will you have to go to the clinic for treatment, tests, blood work, etc.?
- Will I live longer?
The primary goal of palliative chemotherapy is to extend life. You will want to know what the chances are that you will live longer. If the chances are low that you’ll increase your life span, you might decide to forgo it to focus more on comfort measures.
- Will my symptoms be reduced?
Another desired effect of palliative chemotherapy is to improve your symptoms of cancer. By reducing the size of a tumor, the symptoms of cancer may be reduced. You have a right to know what the chances are that your quality of life will be improved.
Several reports have shown that patients who receive palliative chemotherapy didn’t get clear or adequate information about survival rates and quality of life issues from their oncologists. Make sure you are not one of them. The only way you can make the decision that’s right for you is have all the information that’s available.
Sources:
Audrey, S. et al. What oncologists tell patients about survival benefits of palliative chemotherapy and implications for informed consent: qualitative study. British Medical Journal. 2008 July 31;337:a752 doi:10.1136/bmj.a.752.
Ferrell, BR and Coyle, N; Textbook of Palliative Nursing, Oxford University Press, 2006.
