Patients' perspectives on palliative chemotherapy of colorectal and non - colorectal cancer: A prospective study in a chemotherapy- experienced population

BMC Cancer (Impact Factor: 3.36). 02/2013; 13(1):66. DOI: 10.1186/1471-2407-13-66
Source: PubMed


A better understanding of patients’ views on the benefit and burden obtained from palliative chemotherapy would facilitate shared decision making. We evaluated palliative cancer patients’ reported outcomes (PROs) for toxicity and investigated the survival threshold for which they would repeat chemotherapy (CTx).

Patients who had received a minimum of three months of palliative CTx for advanced colorectal (CRC) or non-colorectal (non-CRC: upper gastrointestinal, lung and head-and-neck) cancer were assessed by questionnaire. Patients were questioned about PROs for toxicity, subjective burden from side effects, and were asked for the survival threshold necessary for them to repeat CTx. Expected survival (sum of indicated survival threshold and median survival time with best supportive care) was compared to the patients’ actual survival.

One hundred and thirty-four patients (CRC: 58; non-CRC: 76) were surveyed. The most frequent PRO- grade 3/4 toxicities were acne (12.8%), fatigue (9.0%), and diarrhea (8.5%). The symptom causing the highest subjective burden was fatigue and was worse than expected in 29.9% of the patients. The median survival threshold for which patients would repeat CTx was significantly longer in CRC than in non-CRC patients (p=0.01). Median expected survival was significantly longer than actual median survival (CRC: 44.0 months [22.0-65.9] compared with 30.0 months of actual survival [20.9-39.1]; non-CRC: 22.0 months [15.3-28.6] compared with 19.0 months of actual survival [15.1-22.9], p=0.03).

Fatigue deserves more attention when toxicity of treatment and symptoms of disease are explained to patients. Patients’ survival expectations from palliative chemotherapy are higher than previously described, exceed the median survival time known from phase III trials, and are significantly longer than their actual survival.

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Available from: Uli Schuler, Nov 20, 2014
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    • "ly comprehended the incur - ability of the disease ( Weeks et al . , 2012 ) . Many patients are in - clined to undergo highly toxic PCT even with small chances of beneficial effects ( Harrington and Smith , 2008 ; Matsuyama et al . , 2006 ; Voogt et al . , 2005 ) , and their expectations about survival with PCT often exceed their actual survival ( Mende et al . , 2013 ) . Physicians may be able to facilitate ceasing PCT by providing the patient with realistic information about both advantages and dis - advantages of this treatment ( Audrey et al . , 2008 ) ."
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