Death by chemo

A new study from a Boston cancer center is shedding new light on one of life’s most difficult decisions: Whether and/or when it makes sense for us to fight cancer with chemotherapy.

It is, of course, the call only of the person facing death. But the study raises some questions about whether oncologists are properly telling patients everything that’s involved and whether we’re asking the uncomfortable questions about our own demise, the Boston Globe’s Deborah Kotz says.

The study, from the Dana-Farber Cancer Institute, “found that more than half of end-stage cancer patients receive chemotherapy during the last few months of their life, and those who received such treatment were more likely to die in a hospital intensive care unit, hooked to a ventilator, rather than at home as they would have preferred.”

These patients, the study says, were less likely to have end-of-life discussions with their doctor after getting the bad news.

It’s understandable, at a time when we’re mustering up the courage to face cancer, asking about death seems to undercut the optimism we think is necessary to survive.

“There’s a subtle dance that happens between oncologist and patient,” according to Dr. Alexi Wright, an assistant professor of medicine at Dana-Farber, “where doctors don’t want to broach the subject of dying, especially in younger patients, because it makes those patients think we’re giving up on them.”

Fifty-six percent of those who chose chemotherapy and didn’t have a conversation about end-of-life wishes were younger, better educated, and richer, the study said. Those in the study who took chemotherapy drugs didn’t live any longer than those who didn’t, the Globe writes.

They did, however, receive more painful and costly medical interventions, which led to a worse death: 65 percent died in their preferred place compared to 80 percent of those who stopped treatments. Those taking chemotherapy were more likely to die in a hospital intensive care unit than at home and were more likely to get resuscitated and placed on a ventilator. Not surprisingly, most were referred to hospice very late in the game, within a week before they died.

“Doctors are human beings,” Wright said, “and sometimes we fail to have the clarity to determine when our patients are dying. And even when we do, we may not want to give up on treatments as this study suggests is the case.”

She’s hoping that the findings will raise awareness to help doctors understand that administering chemotherapy to terminally ill patients doesn’t just give them a false sense of hope but also raises the likelihood of denying them a more peaceful death.

Related: Cancer, a burned-out home, and the blessings of friends (NewsCut).