Chemotherapy Use Rises Among Terminal Patients; Economic, Familial Pressures May Drive Its Growing Use Oncologists appear to be treating greater numbers of dying and terminally ill patients with chemotherapy even though such patients traditionally are highly unlikely to benefit from the aggressive treatment, new research suggests. Oncologists are ranked among the highest-paid physicians in the nation, earning much of their income from the sale of chemotherapy to patients. Payments by Medicare to oncologists for providing chemotherapy treatments to patients over age 65 are among Medicare's top expenditures. Follow the money? The study by researchers at Harvard Medical School and the Dana Farber Cancer Institute does not address physicians' motivations for the increase of chemotherapy treatments in terminally ill patients. But economic incentives as well as pressure from patients and families could be factors, the scientists said. "There are no guidelines for oncologists on when to quit," said Craig Earle, who studied the medical records of 28,777 Medicare-eligible patients age 65 and older who died within one year of their diagnosis of lung, breast, colorectal and other gastrointestinal tumors. "When to stop treatment has to be a personal decision. For some, they may need to fight to the end," Earle said. "For others, it may be better to gain some acceptance" about dying. Lung, breast, colorectal, prostate, pancreas and stomach tumors are among the most difficult to treat after cancer cells have spread to other areas of the body. Though a very small percentage of patients do benefit from chemotherapy, the mortality rate during the following year is very high. The study found that use of chemotherapy in these patients increased from 27.9% to 29.5% from 1993 to 1996. Patients were more likely to have: Received chemotherapy within two weeks of death. Started a new chemotherapy treatment in the last month of life. Made emergency room visits and been admitted to an intensive care unit, most likely because of side effects from their treatments or complications from their cancers. If a patient was admitted to a hospice, this was more likely to have occurred in the last three days of life. More treatment options have become available during the study period, suggesting that patients might be exercising more options up to the time of death. However, Earle said, "this suggests that while we have more treatments to offer, sometimes we may not be very judicious with it." The hospice option Earle said the study found that when hospice centers were more available, patients were more likely to use their services and less likely to be treated aggressively. But reimbursement policies for hospice centers discourage patients from receiving even palliative care to relieve symptoms of their cancer. Medical treatments are deducted from hospice center reimbursements, Earle said. "This suggests to me that patients could be helped if we changed the hospice benefit." Robert Mayer of the American Society of Clinical Oncology cautioned against drawing generalizations from the study. He said many factors can influence treatment decisions at the end of life and that it is hard to predict when a patient is going to die. "The slippery slope is when you have the answers (the study data) before you know the questions to ask," Mayer said. "Some older patients should not be treated." But Mayer said he recently treated a woman with advanced colon cancer who was admitted to the hospital. She had not had any prior treatment. After giving her chemotherapy, her condition was improved, and "she is playing now with her grandchildren." Said Mayer: "One size does not fit all." Thanks to: CHICAGO (USA TODAY) --June 4, 2003 J Clin Onco, 3/06 www.plwc.org LINK to NYTimes article by Tom Nessi on the death of his wife Susan. Published June 5, 2003 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.