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  • Print publication year: 2003
  • Online publication date: August 2010

2 - Principles of palliative chemotherapy

Summary

Introduction

Patients with advanced cancer are heterogenous not only with respect to the underlying histology and biology of their cancer, but also in other important ways. Advanced cancer patients also vary with respect to their overall health status, their preferences, the local extent of their underlying disease, the number of sites of their metastatic spread, the overall bulk of their cancer, and their sources of suffering. One of the most important decisions that must be made in caring for these patients is determining the role of anticancer therapy in the comprehensive plan of care. This important decision has implications regarding the number and type of health providers involved in the care, the proper setting for the delivery of care, the third-party and out-of-pocket costs of care, the level of family support necessary to implement the care properly, and the overall trajectory of care. This chapter will address the use of systemic anticancer therapy for advanced cancer patients with a focus on five major questions: (1) Is there a conceptual framework that can be used to inform this decision? (2) What is the range of possible specific goals for this therapy? (3) What are the most useful predictors of response to therapy? (4) What are the broad categories of therapies that are commonly used? (5) How are patients followed once therapy is started?

BIBLIOGRAPHY
Sentinel articles
Burris, H A, Moore, M J, Anderson, J, Green, M R, Rothenberg, M L, Modiano, M R. Improvements in survival and clinical benefit with gemcitabine as first line therapy for patients with advanced pancreas cancer: a randomized trial. J Clin Oncol 1997;15:2403–13
Cassell, E J. The nature of suffering and the goals of medicine. N Engl J Med 1982;306:639–45
Doyle, C, Crump, M, Pintilie, M, Oza, A M. Does palliative chemotherapy palliate? Evaluation of expectations, outcomes, and costs in women receiving chemotherapy for advanced ovarian cancer. J Clin Oncol 2001;19:1266–74
Geels, P, Eisenhauer, E, Bezjak, A, Zee, B, Day, A. Palliative effect of chemotherapy: Objective tumor response is associated with symptom improvement in patients with metastatic breast cancer. J Clin Oncol 2000;18:2395–405
Karnofsky, D A, Abelmann, W H, Craver, L F, Burchenal, J H. The use of nitrogen mustards in the palliative treatment of carcinoma. Cancer 1948;1:634–56
Korn, E L, Arbuck, S G, Pluda, J M, Simon, R, Kaplan, R S, Christian, M C. Clinical trial designs for cytostatic agents: are new approaches needed?J Clin Oncol 2001;19:265–272
Motzer, R J, Mazumdar, M, Bacik, J, Berg, W, Amsterdam, A, Ferrara, J. Survival and prognostic stratification of 670 patients with advanced renal cell carcinoma. J Clin Oncol 1999;17:2530–40
Quill, T E, Arnold, R M, Platt, F. “I wish things were different”: expressing wishes in response to loss, futility, and unrealistic hopes. Ann Intern Med 2001;135:551–5
Saxman, S B, Propert, K J, Einhorn, L H. Long-term follow-up of a phase III intergroup study of cisplatin alone or in combination with methotrexate, vinblastine, and doxorubicin in patients with metastatic urothelial carcinoma: a cooperative group study. J Clin Oncol 1997;15:2564–9
Tannock, I F, Osoba, D, Stockler, M R, et al. Chemotherapy with mitoxantrone plus prednisone or prednisone alone for symptomatic hormone-resistant prostate cancer: a Canadian randomized trial with palliative end points [see comments]. J Clin Oncol 1996;14:1756–64
Therasse, P, Arbuck, S G, Eisenhauer, E A. et al. New guidelines to evaluate the response to treatment in solid tumors. J Natl Cancer Inst 2000;92:205–16
Zubrod, C G, Schneiderman, M, Frei, E. et al. Appraisal of methods for study of chemotherapy of cancer in man. Comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. J Chron Dis 1960;11:7–33
Review articles/book chapters
Ellison, N M. Palliative chemotherapy. Am J Hospice Palliat Care 1998;15:93–103
Ellison N M. Palliative chemotherapy. In Principles and Practice of Supportive Oncology, ed. A Berger, R K Portenoy, D E Weissman, pp. 667–79. Philadelphia, PA: Lippincott–Raven, 1998