Palliative chemotherapy

Palliative care is a form of medical care that is ultimately aimed at relieving the symptoms associated with a serious illness while improving a person’s quality of life. A specialized team of medical and allied health professionals work together to address an individual’s physical, emotional, practical, and spiritual needs. • Providing relief from pain and/or symptoms of a disease • Coordinating care between medical and non-medical providers • Minimizing side effects from treatments • Addressing the emotional, spiritual, and social needs of the individual • Identifying and supporting the needs of the family or caregivers Palliative care is based on the needs of the individual, not the individual’s diagnosis or Palliative Care Team Palliative care is typically carried out by a team of professionals who can address multiple concerns. It may be offered by hospitals, home care agencies, cancer treatment centers, and long-term care facilities. The care team may include: • Physical problems, such as pain, sleeping problems, • Emotional or social problems, including depression, anxiety, family issues, • Practical problems, including insurance, financial, legal, housing, or job-related issues • Spiritual issues, including prayer, finding meaning, even hopelessness and a loss of faith • General clinical criteria: May include multiple hospitalizations, declining ability to take care of oneself, severe weight loss, a need for • Intensive care unit (ICU) criteria: May include two mor...

Many clinical practices and oncologists believe that treating terminally ill cancer patients who may be have 6 months or less of life with chemotherapy may ease symptoms and extend life expectancy. However, researchers with the Weill Cornell Medical College say otherwise. Researchers found in a "This study demonstrates that palliative chemotherapy does not appear to palliate symptoms even in the most robust patients who can tolerate chemotherapy," Holly G. Prigerson, PhD, co-director of the Center for Research on End-of-Life Care and the Irving Sherwood Wright Professor in Geriatrics at Weill Cornell, said in a statement. "It raises questions about the rationale for such aggressive, burdensome care." In examining 661 patients with advanced metastatic disease and cancer progression, researchers employed a scale to determine the patients’ health and functioning a few months prior to their passing and then conducted interviews with the patient’s most closely involved caregivers a week after death to understand physiological and physical distress and overall quality of life. Among their results, the authors found that the quality of life in end-stage patients near death did not improve and in some cases worsened with palliative chemotherapy treatment, even in patients who showed good performance and healthy activity in the beginning of their cancer development. “ASCO [The American Society for Clinical Oncology] has attempted to respond to the need to limit widespread, wa...

From the *Department of Internal Medicine, Palliative Medicine Program, Mayo Clinic, Rochester, MN; and †Division of Hematology/Oncology and Palliative Care, Virginia Commonwealth University Health System, Richmond, VA. Reprints: Thomas J. Smith, MD, Virginia Commonwealth University Health System, Division of Hematology/Oncology and Palliative Care, PO Box 980230, Richmond VA 23298-0230. E-mail: [emailprotected]. One of the most difficult questions oncologists are asked is: "Is the chemotherapy worth it, doctor?" This simple question may entail issues of benefits, risks, existential and religious concern, and financial resources. There is no one right answer, but there is a good way to approach the question. Be direct, and ask the patient what he/she wants to know, what he/she knows about the situation, and what the question means to him/her. In almost all settings, honesty with caring is the best approach, and giving bad news does not make patients depressed or give up hope. For most patients, a switch to palliative care that does not include chemotherapy should happen when the performance status is 3 or greater, defined as more than 50% of time in a bed or chair (not bed alone). In our practice, if the patient has difficulty walking to the clinic, it is time to make the transition. We illustrate some ways that this transition can occur and the benefits of a timely switch to palliative care. © 2010 Lippincott Williams & Wilkins, Inc.

A new triplet regimen, serving as palliative chemotherapy and comprised of erlotinib (Tarceva), celecoxib (Celebrex), and methotrexate improved survival and quality of life among patients with platinum-resistant oral cancer, according to phase I/II study findings published in the Journal of Clinical Oncology. Platinum-resistant oral cancer leaves patients with few options. Among the worst cases, resistance to treatment develops within a month – and for those, the median survival is just 3 to 5 months beyond that, according to the literature. In phase I of the study, investigators identified the optimal biologic dose of methotrexate when given along with erlotinib and celecoxib in 15 patients, which was calculated by assessing the clinical benefit rate at the 2-month mark, and the counts of circulating endothelial cells at the day-8 mark. With this, the investigators determined that 9 mg/m 2 was the optimal biologic dose. In phase II of the study, investigators then aimed to assess the efficacy of the 3-drug regimen in 91 patients, include 76 enrolled as part of the expansion cohort, with After a median follow-up of 6.8 months (range, 0 to 16.8 months), the 3-month progression-free survival (PFS) rate was 71.1% (95% CI, 60.5%-79.3%), the 6-month overall survival rate was 61.2% (95% CI, 49.2%-67.8%), and the response rate was 42.9% (95% CI, 33.2%-53.1%) – including 39 complete responses. Regarding quality of life, the mean Functional Assessment of Cancer Therapy-Head and Nec...