From Times Online – David Rose

Doctors have been urged to be more cautious in offering cancer treatment to terminally-ill patients as chemotherapy can often do more harm than good, a study suggests.

Patients with incurable cancers were promised much greater access to the latest drugs which could offer them extra months or years of life by a Department of Health review last week.

Such medicines are often taken or injected as part of a “cocktail” of chemotherapy drugs.

But the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) found that more than four in ten patients who received chemotherapy towards the end of life suffered potentially fatal effects from the drugs, and treatment was “inappropriate” in nearly a fifth of cases.

About 300,000 patients now receive chemotherapy in the UK each year, a 60 per cent increase compared to 2004.

But in a study of more than 600 cancer patients who died within 30 days of receiving treatment, chemotherapy probably caused or hastened death in 27 per cent of cases, the inquiry found.

In only 35 per cent of these cases was care judged to have been good by the inquiry’s advisors, with 49 per cent having room for improvement and 8 per cent receiving less than satisfactory care.

More than one fifth of patients were already severely debilitated at the time the decision to treat with chemotherapy was taken, while that many could not make an informed consent to treatment, the report said.

Mark Lansdown, surgical oncologist at Leeds General Infirmary, and a co-author of the report, said that it is usual for patients to suffer some side-effects following chemotherapy, but that very few patients die as a consequence.

“The majority of patients in this study were receiving palliative treatment where the aim is to alleviate symptoms of cancer with the minimum of side effects,” which represented a small proportion (2 per cent) of all patients receiving the treatment, he said.

“Yet 43 per cent of all patients in the study suffered significant treatment-related toxicity.”

The proportion of deaths attributed to chemotherapy “is of particular concern for the 14 per cent of patients for whom [it] was intended to cure them of their cancer,” he added.

Co-author Diana Mort, of Velindre NHS Trust, Cardiff, said that treatment can also result in life-threatening infections or patients may simply die of their cancer.

“[But] patients must be made aware of the risks and side effects of chemotherapy as well as the potential benefits. They should be given time to reflect on their decision and must always be free to change their minds.”

The Government’s national cancer director, Professor Mike Richards, said that he was “very concerned” by the report’s findings.

The National Chemotherapy Advisory Group will publish a full response to the NCEPOD report today, “to bring about a step change in the quality and safety of chemotherapy services for adult patients,” he added.

“I am asking all chemotherapy service providers to consider these reports urgently and to reassess their own services immediately against the measures we have set nationally.”

Katherine Murphy, director of the Patients Association, commented: “too many clinicians have a cavalier attitude to providing information on cancer outcomes, when they should be doing everything in their power to raise standards and give full information to their patients.”

Jane Maher, Chief Medical Officer at Macmillan Cancer Support added: “Doctors and nurses need to be much better at helping patients understand the pros and cons of such powerful treatments in the last year of life.

“Some patients may not be getting the right information and support before deciding whether to start chemotherapy and even more importantly, when enough is enough.

“Something clearly needs to be done – I welcome a prompt response by the National Chemotherapy Advisory Group.”