What Do Oncologists Say about Chemotherapy at the Very End of Life? Results from a Semiqualitative Survey

Aim: This study elicited oncologists' insights into published statistics that 20% of cancer patients receive chemotherapy within 2 weeks of death and that the median survival between chemotherapy administration and death is 37 days. Subjects and methods: A semiqualitative survey was developed to enable respondents to provide anonymous, write-in comments on the statistics above. This survey was sent electronically on two separate occasions to oncologists in the upper midwestern United States. Qualitative methods were used to analyze data. Results: A total of 422 oncology health-care providers were sent the survey, and 61 responded. Nine themes emerged: 1) these decisions are strongly patient-driven; 2) newer agents are driving the decision to continue with cancer treatment; 3) financial incentives on the part of the medical community explain these high rates; 4) health-care reform is necessary; 5) even a small chance of patient benefit justifies this practice; 6) this practice is detrimental to patients because it precludes the initiation of hospice services; 7) others may be prescribing in this manner, but "not us''; 8) these issues are complicated, revolve around society values, and the oncologist alone cannot claim responsibility for such high rates of chemotherapy administration; and 9) there exist barriers to end-of-life discussions. Conclusion: Many oncologists are in fact reluctant to prescribe chemotherapy at the end of life, and the complexity of this topic underscores the potential for oncologists and palliative care providers to collaborate in an effort to provide cancer patients the best care at the very end of life.