Skip to main content

Palliative Chemotherapy

by: Robert Killeen MD

Is there anyone amongst the readership that can direct me to a list, a compendium of purely "palliative" chemotherapy regimens? I'm looking specifically for any reference on regimens (ie singlets, doublets, etc +/- RT) designed for non-curative symptomatic treatment. I've scanned EPERC, AAHPM, and the Feinberg Palliative Oncology sites, among others, without much success.

The best definition of a palliative chemotherapy regimen I've found had been derived earlier this decade by a European panel (1). Though their focus was on breast cancer their directive seems applicable across the board. Their opinion was that the optimum palliative regimen should control the disease (ie the response rate, RR) in at least 20-30% of patients and increase the progression-free (PFS) and overall survivals (OS). The regimen's toxicities should, ideally, minimally affect performance status while maximally eliminating tumor symptomatology. Quality of life, not curative intent, was foremost in their consensus.

Those who have treated metastatic or recurrent solid tumors recall that, with the exception of testicular cancer, the course is typically that of a "running battle". There are repeated periods of tumor growth and subsequent treatment followed by periods of dormancy.

Because of comorbidities some patients may not be able to tolerate a full course or cycle of chemotherapy. Even with dose attenuation patients may still lose that personal 'physical reserve' that enables them to maintain long term treatment.

A compendium of palliative chemotherapy regimens can be just as useful for patient care as any tome of standard (neo)adjuvant protocols. If anyone knows of such a book or reference please comment.

Thanks,

Reference;
1) Crown J, Dieras V, Kaufmann M, etal. Chemotherapy for metastatic breast cancer - report of a European expert panel. The Lancet Oncology. 2002;3:719-727.

Comments

vandana said…
HELLO,
A VERY GOOD AND SAFE CHEMO WHICH CAN BE USED IN VARIOUS ADVANCED CANCERS(H&N, BREAST, LUNG, ETC),
INJ.METHOTREXATE 50 MG WEEKLY,I/V SLOW BOLUS,WITH CBC MONITORING.THIS CAN BE GIVEN FOR LONG PERIODS OF TIME, TO VERY OLD AND POOR GC PATEINTS.
DR.VANDANA WILLIAMS.ST.STEPHENS HOSPITAL,DELHI.
Anonymous said…
I don’t know if you already know of Betty Ferrell, RN, PhD who is a Research Scientist  at the City of Hope National Medical Center in Duarte, CA.  If such a compendium exists, she would know.  She is the editor of an amazing textbook on Palliative Nursing.  Good Luck!
Anonymous said…
You can't find a protocol because there is no such thing. Chemotherapy produces symptoms, usually more symptoms than it relieves.

Popular posts from this blog

Lost in Translation: Google’s Translation of Palliative Care to ‘Do-Nothing Care’

by: Cynthia X. Pan, MD, FACP, AGSF (@Cxpan5X)

My colleagues often ask me: “Why are Chinese patients so resistant to hospice and palliative care?” “Why are they so unrealistic?” “Don’t they understand that death is part of life?” “Is it true that with Chinese patients you cannot discuss advance directives?”

As a Chinese speaking geriatrician and palliative care physician practicing in Flushing, NY, I have cared for countless Chinese patients with serious illnesses or at end of life.  Invariably, when Chinese patients or families see me, they ask me if I speak Chinese. When I reply “I do” in Mandarin, the relief and instant trust I see on their faces make my day meaningful and worthwhile.

At my hospital, the patient population is about 30% Asian, with the majority of these being Chinese. Most of these patients require language interpretation.  It becomes an interesting challenge and opportunity, as we often need to discuss advance directives, goals of care, and end of life care options…

Delirium: A podcast with Sharon Inouye

In this week's GeriPal podcast we discuss delirium, with a focus on prevention. We are joined by internationally acclaimed delirium researcher Sharon Inouye, MD, MPH. Dr Inouye is Professor of Medicine at Harvard Medical School and Director of the Aging Brain Center in the Institute for Aging Research at Hebrew SeniorLife.

Dr. Inouye's research focuses on delirium and functional decline in hospitalized older patients, resulting in more than 200 peer-reviewed original articles to date. She has developed and validated a widely used tool to identify delirium called the Confusion Assessment Method (CAM), and she founded the Hospital Elder Life Program (HELP) to prevent delirium in hospitalized patients.

We are also joined by guest host Lindsey Haddock, MD, a geriatrics fellow at UCSF who asks a great question about how to implement a HELP program, or aspects of the program, in a hospital with limited resources.  


You can also find us on Youtube!


Listen to GeriPal Podcasts on:
iTunes…

Are Palliative Care Providers Better Prognosticators? A Podcast with Bob Gramling

Estimating prognosis is hard and clinicians get very little training on how to do it.  Maybe that is one of the reasons that clinicians are more likely to be optimistic and tend to overestimate patient survival by a factor of between 3 and 5.  The question is, aren't we better as palliative care clinicians than others in estimating prognosis?  This is part of our training and we do it daily.   We got to be better, right? 

Well, on todays podcast we have Bob Gramling from the Holly and Bob Miller Chair of Palliative Medicine at the University of Vermont to talk about his paper in Journal of Pain and Symptom Management (JPSM) titled “Palliative Care Clinician Overestimation of Survival in Advanced Cancer: Disparities and Association with End of Life Care”.

Big findings from this JPSM paper include that we, like all other clinicians, are an optimistic bunch and that it actually does impact outcomes.   In particular, the people whose survival was overestimated by a palliative care c…