Palliative Chemotherapy-An Oxymoron


Advanced cancer patients worldwide are offered chemotherapy and radiotherapy under the guise and pretense that it is “palliative”. The majority of patients have virtually no idea what they are getting themselves into. The term “palliative” remains one of the most misused and confounding words in the English language. Most of the time it is used in a euphemistic manner in order to avoid using the unmitigated/unequivocal and more honest statement-“You are incurable and thus terminally ill”.

Where is the evidence that Palliative Chemotherapy actually improves pain and symptom management. Only optimal palliative pain and symptom management (opioids, adjuvants, etc) has been shown to lessen the multitude of symptoms from advanced cancer. More often than not, systemic chemotherapies create more distress through CINV, painful neuropathies, skin disorders, hematologic complications, etc. The only example in the medical literature of truly “palliative chemotherapy” is electrochemotherapy used on malignant wounds. A couple of systematic reviews show that this technique actually reduces pain, exudates, and odours resulting from such wounds.

In summary, let’s avoid using the arcane and oxymoronic expression “Palliative Chemotherapy” and replace it with “Non-curative/potentially life-prolonging chemotherapy”.

Advertisements

About drvincentmaida

Consultant in Palliative Medicine & Wound Management, Assistant Professor, University of Toronto & McMaster University, Researcher & Author.
This entry was posted in Uncategorized and tagged , . Bookmark the permalink.

2 Responses to Palliative Chemotherapy-An Oxymoron

  1. Kimberly says:

    I’d like to share the WHO definition of palliative care:
    “Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual. Palliative care:
    provides relief from pain and other distressing symptoms;
    affirms life and regards dying as a normal process;
    intends neither to hasten or postpone death;
    integrates the psychological and spiritual aspects of patient care;
    offers a support system to help patients live as actively as possible until death;
    offers a support system to help the family cope during the patients illness and in their own bereavement;
    uses a team approach to address the needs of patients and their families, including bereavement counselling, if indicated;
    will enhance quality of life, and may also positively influence the course of illness;
    is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.”
    Hence I’m not convinced that palliative chemotherapy is a mis-statement but would rather agree with your valid point that as health care providers it is prudent to provide patients with an understanding of their terminal condition, with honesty and clarity, in language they can understand – rather than hiding behind misunderstood and not easily understood medical terms to avoid uncomfortable and difficult conversations about the realities of a patient’s illness.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s