Importance of avoiding late cancer-directed therapy in terminally ill cancer patients

  • 5 Accesses


It is undeniably a great challenge to adequately weigh the benefits and harms of tumor-specific therapy near the end of life and to find the right time for changing the objective of therapy to palliative care alone. In a curative situation, the “survival” benefit of the treatment outweighs its potential harm due to side effects. However, things are different when the possibility of cure is ruled out. Important prerequisites to avoid overly zealous care are adequate communication about the therapeutic options and consensus between the doctor and the patient with regard to the (realistic) therapeutic goal, a realistic estimated prognosis and early integration of palliative care.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA


  1. 1.

    Henson LA, Gomes B, Koffman J, Daveson BA, Higginson IJ, Gao W, et al. Factors associated with aggressive end of life cancer care. Support Care Cancer. 2016;24(3):1079–89.

  2. 2.

    Martoni AA, Tanneberger S, Mutri V. Cancer chemotherapy near the end of life: the time has come to set guidelines for its appropriate use. Tumori. 2007;93(5):417–22.

  3. 3.

    Goncalves JF, Goyanes C. Use of chemotherapy at the end of life in a Portuguese oncology center. Support Care Cancer. 2008;16(4):321–7.

  4. 4.

    Nappa U, Lindqvist O, Rasmussen BH, Axelsson B. Palliative chemotherapy during the last month of life. Ann Oncol. 2011;22(11):2375–80.

  5. 5.

    Emanuel EJ, Young-Xu Y, Levinsky NG, Gazelle G, Saynina O, Ash AS. Chemotherapy use among Medicare beneficiaries at the end of life. Ann Intern Med. 2003;138(8):639–43.

  6. 6.

    Earle CC, Neville BA, Landrum MB, Ayanian JZ, Block SD, Weeks JC. Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol. 2004;22(2):315–21.

  7. 7.

    Matsuyama R, Reddy S, Smith TJ. Why do patients choose chemotherapy near the end of life? A review of the perspective of those facing death from cancer. J Clin Oncol. 2006;24(21):3490–6.

  8. 8.

    Saito AM, Landrum MB, Neville BA, Ayanian JZ, Earle CC. The effect on survival of continuing chemotherapy to near death. BMC Palliat Care. 2011;10:14.

  9. 9.

    Wright AA, Zhang B, Keating NL, Weeks JC, Prigerson HG. Associations between palliative chemotherapy and adult cancer patients’ end of life care and place of death: prospective cohort study. BMJ. 2014;348:g1219.

  10. 10.

    Keam B, Oh DY, Lee SH, Kim DW, Kim MR, Im SA, et al. Aggressiveness of cancer-care near the end-of-life in Korea. Jpn J Clin Oncol. 2008;38(5):381–6.

  11. 11.

    Prigerson HG, Bao Y, Shah MA, Paulk ME, LeBlanc TW, Schneider BJ, et al. Chemotherapy use, performance status, and quality of life at the end of life. JAMA Oncol. 2015;1(6):778–84.

  12. 12.

    Schnipper LE, Smith TJ, Raghavan D, Blayney DW, Ganz PA, Mulvey TM, et al. American Society of Clinical Oncology identifies five key opportunities to improve care and reduce costs: the top five list for oncology. J Clin Oncol. 2012;30(14):1715–24.

  13. 13.

    van Oorschot B. Krebs im Endstadium: Überengagierte Versorgung am Lebensende. Dtsch Arztebl Int. 2018;115(47):16.

  14. 14.

    Enzinger AC, Zhang B, Schrag D, Prigerson HG. Outcomes of prognostic disclosure: associations with prognostic understanding, distress, and relationship with physician among patients with advanced cancer. J Clin Oncol. 2015;33(32):3809–16.

  15. 15.

    Glare P, Virik K, Jones M, Hudson M, Eychmuller S, Simes J, et al. A systematic review of physicians’ survival predictions in terminally ill cancer patients. BMJ. 2003;327(7408):195–8.

  16. 16.

    Christakis NA, Lamont EB. Extent and determinants of error in doctors’ prognoses in terminally ill patients: prospective cohort study. BMJ. 2000;320(7233):469–72.

  17. 17.

    Stone PC, Lund S. Predicting prognosis in patients with advanced cancer. Ann Oncol. 2007;18(6):971–6.

  18. 18.

    Gwilliam B, Keeley V, Todd C, Gittins M, Roberts C, Kelly L, et al. Development of Prognosis in Palliative care Study (PiPS) predictor models to improve prognostication in advanced cancer: prospective cohort study. BMJ Support Palliat Care. 2015;5(4):390–8.

  19. 19.

    Weeks JC, Catalano PJ, Cronin A, Finkelman MD, Mack JW, Keating NL, et al. Patients’ expectations about effects of chemotherapy for advanced cancer. N Engl J Med. 2012;367(17):1616–25.

  20. 20.

    Bluhm M, Connell CM, De Vries RG, Janz NK, Bickel KE, Silveira MJ. Paradox of prescribing late chemotherapy: oncologists explain. J Oncol Pract. 2016;12(12):e1006–e15.

  21. 21.

    Epstein AS, Prigerson HG, O’Reilly EM, Maciejewski PK. Discussions of life expectancy and changes in illness understanding in patients with advanced cancer. J Clin Oncol. 2016;34(20):2398–403.

  22. 22.

    Mack JW, Weeks JC, Wright AA, Block SD, Prigerson HG. End-of-life discussions, goal attainment, and distress at the end of life: predictors and outcomes of receipt of care consistent with preferences. J Clin Oncol. 2010;28(7):1203–8.

  23. 23.

    Barclay JS, Kuchibhatla M, Tulsky JA, Johnson KS. Association of hospice patients’ income and care level with place of death. JAMA Intern Med. 2013;173(6):450–6.

  24. 24.

    Wright AA, Keating NL, Balboni TA, Matulonis UA, Block SD, Prigerson HG. Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers’ mental health. J Clin Oncol. 2010;28(29):4457–64.

  25. 25.

    Smith CB, Phillips T, Smith TJ. Using the new ASCO clinical practice guideline for palliative care concurrent with oncology care using the TEAM approach. Am Soc Clin Oncol Educ Book. 2017;37:714–23.

  26. 26.

    Bakitas MA, El-Jawahri A, Farquhar M, Ferrell B, Grudzen C, Higginson I, et al. The TEAM approach to improving oncology outcomes by incorporating palliative care in practice. J Oncol Pract. 2017;13(9):557–66.

Download references

Author information

Correspondence to Dr. Daniela Jahn-Kuch MSc.

Ethics declarations

Conflict of interest

D. Jahn-Kuch declares that she has no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Jahn-Kuch, D. Importance of avoiding late cancer-directed therapy in terminally ill cancer patients. memo (2020) doi:10.1007/s12254-019-00564-1

Download citation


  • Palliative care
  • Terminal care
  • Communication
  • Neoplasms
  • Prognosis