CLINICIAN'S CORNER The Role of Chemotherapy at the End of Life "When Is Enough, Enough?" Sarah Elizabeth Harrington, MD; Thomas J. Smith, MD JAMA. 2008;299(22):2667-2678. Patients face difficult decisions about chemotherapy near the end of life. Such treatment might prolong survival or reduce symptoms but cause adverse effects, prevent the patient from engaging in meaningful life review and preparing for death, and preclude entry into hospice. Palliative care and oncology clinicians should be logical partners in caring for patients with serious cancers for which symptom control, medically appropriate goal setting, and communication are paramount, but some studies have shown limited cooperation. We illustrate how clinicians involved in palliative care and oncology can more effectively work together with the story of Mr L, a previously healthy 56-year-old man, who wanted to survive his lung cancer at all costs. He lived 14 months with 3 types of chemotherapy, received chemotherapy just 6 days before his death, and resisted entering hospice until his prognosis and options were explicitly communicated. Approaches to communication about prognosis and treatment options and questions that patients may want to ask are discussed. Ann's NOTE: We were alerted to this article from Oncology e-news of June 19, 2008 shown below. In 2001, Dr. E.Emanuel presented at talk at ASCO (American Society for Clinical Oncology in which he criticized the continued use of chemotherapy at end of life. ``What we found is that in the last year of life, 41% of patients received chemotherapy, 33% had chemotherapy in the last 6 months of life and 25% received chemotherapy in the last 3 months of life,'' he said. ASCO talk presented by Dr. Ezekiel J. Emanuel, NCI, May 2001 + + + + + + + + + + Apparently this practice is still continuing and palliative care specialist along with advocates must work harder to change this. End of Life Guidance from JAMA expanded HONIonline, June 2008 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.