Background Research undertaken in patients with a cancer diagnosis and poor performance status (PS) has shown a lack of survival benefit or improved quality of life from chemotherapy.1,2,3 A review by the National Confidential Enquiry into Patient Outcome and Death found that poor PS was linked to an increased rate of death within 30 days of systemic anti-cancer therapy (SACT).4 We analysed survival duration in patients with a poor PS prescribed SACT in our local NHS trust.
Methods Details for all patients who were prescribed SACT in the Mid Yorkshire Hospitals NHS Trust from 1/1/2015 to 31/12/2015 were obtained from the electronic prescribing system (chemocare) and electronic case records (PPM). Patients included had an Oncological ICD-10 classification and had a performance status of 2 or less at the start of cycle 1 of treatment. Duration of survival for these patients was calculated.
Results From the total 747 patients, 39 were identified to fit the criteria. 33 had a PS of 2, and 6 had PS of 3 at the first cycle of SACT. Common diagnoses were lung carcinoma (n=23) and breast carcinoma (n=8). 35 patients received chemotherapy with palliative intent. 3 of these patients died within 30 days of receiving SACT, and a total of 8 patients died within 60 days (23%). All 4 patients who received neoadjuvant, adjuvant or disease modifying chemotherapy were still alive at time of analysis, with a survival of at least 421 days.
Conclusions Nearly 1 in 4 patients with a PS of 2 or less who were prescribed palliative chemotherapy had died within 60 days of receiving SACT. Quality of life and best supportive care need to be the first consideration for patients with poor PS, but carefully chosen and counselled patients with chemosensitive disease can benefit from SACT (further research needed).
References 1. Sánchez-Muñoz, Pérez-Ruiz, Sáez MI, et al. Limited impact of palliative chemotherapy on survival in advanced solid tumours in patients with poor performance status. Clin Transl Oncol 2011;13(6):426–9.
2. Wright AA, Zhang B, Keating NL, et al. Associations between palliative chemotherapy and adult cancer patients‘ end of life care and place of death: prospective cohort study. BMJ 2014;4:348.
3. Prigerson H, Bao Y, Shah M, et al. Chemotherapy Use, Performance Status, and Quality of Life at the End of Life. JAMA Oncol 2015;1 (6):778–784.
4. Mort D, Lansdown M, Smith N, et al. Systemic Anti-Cancer Therapy: For better, for worse? National Conï¬ dential Enquiry into Patient Outcome and Death. [Online] Available at: http://www.ncepod.org.uk/2008report3/Downloads/ SACT_report.pdf (accessed September 4 th, 2016)
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