Aggressive Cancer Treatments at End of Life

Russ Krengel Diseases

When a patient receives a cancer diagnosis, it’s common to undergo harsh and extreme treatments in pursuit of a cure. The treatments might be difficult to endure, but patients persevere because they hope to be disease-free. If, on the other hand, the cancer diagnosis is terminal, patients will still undergo treatment, even though a cure may not be possible.

In fact, according to Helmneh M. Sineshaw, MD, MPH of the American Cancer Society, nearly a third of patients with metastatic colorectal cancer had surgery a month before they died, and patients with other terminal cancer diagnoses were undergoing chemotherapy or radiation treatments shortly before death.

Are these treatments meaningful or effective for patients at the end of life? Are there alternatives for terminal cancer patients who don’t want to undergo these extreme treatments?

Why Terminal Cancer Patients Choose Aggressive Treatments

Often, terminal cancer patients will choose to undergo chemotherapy and radiation treatments instead of palliative or hospice treatments. They may have several reasons for this.

These reasons may include:

  • Prolonging Life: The patient’s simple desire to stay alive and close to their loved ones may motivate them to continue or pursue these treatments.
  • Misleading Information from the Doctor: In an effort to give the patient hope, their doctor might downplay the illness. Acting on that information, the patient may choose to undergo these harsh treatments.
  • Patient Optimism: The patient may feel overly optimistic about their own condition. This could lead to the employment of aggressive treatments.
  • Available Family Resources: Family members may discuss the treatment plan and determine what resources are available for the patient’s use.

Due to these and other reasons, a terminal cancer patient may choose to undergo radiation and chemotherapy treatments, even though these procedures wouldn’t save their lives.

Which Patients Are Choosing Aggressive Treatments?

Of course, not all terminal cancer patients are good candidates for chemotherapy and radiation, and others may make the decision to forego these treatments in favor of preserving their quality of life, or for financial reasons. Which patients do choose these treatments, though?  

May Be Dependent on Type of Cancer

Dr. Sineshaw’s research focused on four common types of cancer, metastatic pancreatic, lung, colorectal, and breast cancers. He discovered that among the patients they studied, who received their diagnosis within a month of death, over two-thirds had lung cancer, but a little less than a third of those patients with lung cancer received any cancer-specific treatment.

By contrast, 12% had colorectal cancer and a little less than 4% had breast cancer, and of those patients, a little over 37% of those with colorectal cancer and 34% of those with breast cancer underwent cancer-specific treatments.

Further study is necessary to determine if the results of this research indicate a general trend for terminal cancer patients and their treatment plans.

Treatment Type May Vary

The study focused on four types of cancer treatments, radiotherapy, chemotherapy, surgery, and hormone therapy.

Nearly a third of patients with colorectal cancer had surgery to the primary tumor. Almost a quarter of patients with breast cancer underwent hormone treatment while 11.3% of patients with lung and breast cancer went through chemotherapy. 18.7% of lung cancer patients had radiotherapy.

Insurance Coverage Plays a Role in What Treatments Are Feasible

Of course, insurance coverage determines what kinds of treatments a patient can undergo. Underinsured or uninsured patients are unlikely to be able to have more invasive or aggressive forms of treatment, such as surgery or chemotherapy.

Although the percentages of patients undergoing treatments in this study are fairly low, all of these patients were diagnosed and treated within a month of their death. With this in mind, it’s sobering to consider what factors might have influenced these patients to undergo such aggressive treatments.

Factors Influencing What Type of Treatment a Patient Receives

Aside from the patient’s wishes, researchers are looking into figuring out which patients would best benefit from aggressive treatments. Two existing studies from France and Sweden found terminal cancer patients often undergo harsh or invasive therapies within 30 days of their death.

Dr. Sineshaw discovered among the patients who died within a month of their cancer diagnosis between 2004 and 2014, about 27% of them received aggressive therapies, but most oncologists had reservations about going to extraordinary measures for terminal patients.

Possible reasons why a doctor would provide aggressive treatment to a terminal patient might include age and comorbidity score. Patients over the age of 75 and patients with a high comorbidity score are less likely to be candidates for radiation or chemotherapy, while younger patients and patients with low comorbidity may be given these treatments, even if they are terminally ill.

Reach Out to Kindful Hospice to Learn More about Cancer Treatments

If you’re curious about which cancer treatments will be most beneficial to you, please contact our medical professionals at Kindful Hospice. They can help you determine what treatment plan will work best for your healthcare goals.

Our team can help you figure out whether or not aggressive treatments like chemotherapy and radiation would be beneficial for you.