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Cancer chemotherapy is the use of drugs to destroy cancer cells. Chemotherapy is usually prescribed by oncologists (physicians with advanced training in treatment of cancer). The June 11, 2008, issue of JAMA includes an article assessing the difficult decisions cancer patients and their doctors must make about the use and extent of chemotherapy as patients near the end of life.
The type of cancer, what organs are affected, age, health, and the goals and adverse effects of treatment are important issues. One of the most important issues is your "performance status," rated on the following scale. Patients with a performance status of 3 or 4 usually should not receive chemotherapy because they will have little chance of benefit and more adverse effects.
0 Fully active
1 Restricted in physically strenuous activity but ambulatory (able to walk) and able to carry out work of a light or sedentary nature, such as light housework or office work
2 Ambulatory and capable of all self-care but unable to carry out any work activities; up and about more than 50% of waking hours
3 Capable of only limited self-care; confined to bed or chair more than 50% of waking hours
4 Completely disabled; cannot carry on any self-care; totally confined to bed or chair
• What is my performance status?
• What is my chance of cure?
• What is the chance that this chemotherapy will make my cancer shrink?
• Will I live longer with chemotherapy? How much longer?
• What are the main adverse effects of the chemotherapy?
• Will I feel better or worse from the chemotherapy?
• Are there nonchemotherapy options such as hospice or palliative care?
• Are there clinical trials available?
• What are the benefits?
• Am I eligible?
• What is needed to enroll?
• What are the likely things that will happen to me?
• How long will I live? (Ask for a range, and the most likely scenario for the period ahead, and when death might be expected.)
• Are there other things I should be doing?
• Advance directives
• Durable attorney for health care (Who can speak for me if I am unable?)
• Financial or legal issues
• Family issues (Will you help me talk with my family?)
• Spiritual and psychological issues (Who is available to help me cope with this situation?)
• Legacy and life review (What do I want to pass on to my family about my life?)
American Cancer Society
National Cancer Institute
To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA's Web site at http://www.jama.com. Many are available in English and Spanish. A Patient Page on clinical trials was published in the June 9, 2004, issue; and one on radiation therapy was published in the September 14, 2005, issue.
Sources: American Cancer Society, National Cancer Institute
The JAMA Patient Page is a public service of JAMA. The information and recommendations appearing on this page are appropriate in most instances, but they are not a substitute for medical diagnosis. For specific information concerning your personal medical condition, JAMA suggests that you consult your physician. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. To purchase bulk reprints, call 312/464-0776.
Zeller JL, Lynm C, Glass RM. Cancer Chemotherapy. JAMA. 2008;299(22):2706. doi:10.1001/jama.299.22.2706
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