chemotherapy at end of life?????
A recent multi-institutional longitudinal cohort study assessed the use of chemotherapy in patients with progressive metastatic cancer, assessing survival, quality of life (QOL), and the relationship to performance status (see cancer ctx endoflife jamaonc2015 in dropbox, or doi:10.1001/jamaoncol.2015.2378). background: --the American Society of Clinical Oncology (ASCO) in 2012 published a list of their "Choosing-Wisely" 5 opportunities to improve care and decrease costs, noting that chemotherapy use among patients with no evidence of clinical benefit was the most wasteful, unnecessary and widespread practice in oncology, especially in those with poor performance status with an Eastern Cooperative Oncology Group (ECOG) score of 3 or more ("capable of only limited self-care, confined to bed or chair >50% of waking hours"). Older studies from the 1980s have confirmed that those with poor performance had low response rates to chemotherapy, high rates of toxi...