Let Us Avoid Overtreatment That Can Cause Death in Cancer!

In our first article, deaths within the first 1 month after chemotherapy were defined as chemotherapy-related, and the first of two main causes, deaths from treatment adverse effects, was discussed in detail. In this second article, “Can chemotherapy-related deaths be reduced?”, we discuss overtreatment.

Excessive chemotherapymeans continuing single or combination chemotherapy in advanced, fourth-stage patients despite progression through multiple treatment lines and poor performance status. This increases chemotherapy-related mortality. In nonhematological stage four cancers, chemotherapy aims to relieve symptoms and prolong life, not cure. This should be reasonably and adequately discussed with families without seeking complete eradication.

Relatives hoping for cure in advanced, metastatic disease pressure doctors worldwide for more treatment. Overwhelmed physicians or those struggling to explain stopping treatment and end-of-life care may continue chemotherapy regardless of circumstances, increasing mortality.

In developed countries, after several guideline-based regimens fail and evidence-based options end, treatment stops and patients enter Hospice palliative units. These aim to improve quality of life and relieve symptoms, ideally providing maximum comfort at home with family. Such professional organizations are being defined in our country but are not yet routine.

In Eastern countries such as ours, belief in healers encourages intense searches for cure. Though seemingly harmless, relatives use more alternative products and press physicians for rescue strategies. I observe these searches sometimes resemble the saying, “the greedy person finds the swindler,” leading to wrong paths and hope merchants. Precious time is exchanged for overtreatment, alternative-product adverse effects and poor quality of life.

Prevention requires stronger communication and comprehensive education planned from treatment’s beginning. Specially defined and trained palliative care teamsin oncology clinics are essential. Managing quality of life after chemotherapy becomes inappropriate is as valuable as other care. We hope hospice clinics develop rapidly and increase here as in developed countries.

A French Study Presented at ESMO 2016:

It examined decisions to give chemotherapy in the last three months of life, analyzing 280.000 deceased cancer patients. %20 received chemotherapy in their last month. It was more common in men, younger patients, those without comorbidity and head/neck, breast, lung and gynecological cancers. Clinics with palliative services gave less chemotherapy in the final months. Delegates strongly emphasized, “our target for chemotherapy in the last 1 month should be %0.” This requires discussing end-of-life management much earlier with patients and relatives.

Even in developed France, %20 receiving chemotherapy in their final month is striking.

I assume our rate is lower and hope strategies reduce it further. We should measure our own outcomes and follow appropriate strategies.