Prospective Cohort Study of Palliative Chemotherapy

Prospective Cohort Study of Palliative Chemotherapy



so palliative chemotherapy is chemotherapy given to metastatic cancer patients it's not intended to cure them it is intended to prolong their life and ease their symptoms so the point of this study was to compare our sample of metastatic cancer patients to see whether those who are on palliative chemo differed in their outcomes from those who were not on palliative chemo the outcomes that we looked at were invasive procedures received in the last week of life and also whether they died where the caregiver thought that they would have wanted to die other research in in the past had looked at how patients perceive palliative chemotherapy if they realize that its curative or not and what the the intent dependent of chemotherapy is we wanted to know whether patients who received palliative chemotherapy had different outcomes several months later than those who did not we found that approximately 56% of people were getting palliative chemotherapy about four months before they died and for those patients who were getting chemotherapy we found that patients were much more likely to undergo cardiopulmonary resuscitation or ventilation in the last week of their life they were also more likely to die in an intensive care unit or die some somewhere other than where they really wanted to die the clinical implications are that oncologists and patients need to need to better understand that the patient is terminally ill patients need to acknowledge that the chemotherapy that they're receiving is not intended to cure them but it's intended to palliate them that's the purpose of getting chemotherapy at that time in their course of their just up there LS in the future clinicians can benefit oncologists can benefit from having data that shows you know maybe getting palliative chemotherapy isn't doing what we're hoping it will do maybe it isn't prolonging their life maybe it isn't improving and easing they're reducing the symptom burden of patients who are dying I think it matters to ask the patient's where they want to die it's a difficult conversation to have but one that's necessary because sometimes you don't know similarly it's important to know whether patients would want to be put on a ventilator or want to undergo cardiopulmonary resuscitation if they were close to dying those are things that often we worry about taking away patients hope if we if we ask about it but an earlier work that we've done we've found that that isn't the case so what I've learned is important to ask patients what what they want and family members and then what if if they do want to avoid being resuscitated or put on a ventilator you know to actually get orders in place get a do not resuscitate order in place so that they aren't given more care than they want at the end of their life what this taught me was not that palliative chemo therapies futile I don't believe that at all rather it taught me that while I'm giving chemotherapy I need to make sure that I understand what my patients want for their end-of-life care and make sure that we set up the things that are necessary so that they can get the care that they want patients need to realize that there they might you know one has a crystal ball but their life expectancy is less than six months and that can be fairly accurately determined if that's your life expectancy and you have an incurable cancer and you are receiving chemotherapy that's called palliative chemotherapy it's intended to prolong your life and easier symptom burden it might not do either it might in fact make things worse so that's the discussion if patients want that and and feel like palliative chemotherapy gives them hope or it just shouldn't be false hope that this is going to cure them it should be they should have data like from studies such as this that inform them of what the costal costs are for taking tentative chemotherapy when you're that sick and that advanced in your illness

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