Treatment rate high at end of life for prostate cancer patients

Nov 1 2012

By Sarah Guy, medwireNews Reporter

Approximately one-third of men with castration-resistant prostate cancer (CRPC) receive some form of treatment in the last 3 months of life, show US study results.

The findings also indicate, however, that a quarter of such patients experience adverse events including neutropenia, vomiting/nausea, and febrile neutropenia. The impact of such treatment on quality of life may therefore outweigh its impact on survival, the researchers suggest.

"Because of its potential to become a life-threatening condition, patients with febrile neutropenia are often hospitalized, evaluated, and administered antibiotics. It is not only time demanding but also costly," contend Hanna Zaghloul and colleagues from The Methodist Hospital in Houston, Texas, USA.

Furthermore, administering a new treatment regimen near the end of life, or continuing treatment when death is imminent, can result in more toxicity than palliation "and may be considered overly aggressive" they add in the American Journal of Hospice and Palliative Care.

Using data for 88 men with CRPC who were treated, and died, at a 900-bed US institution between January 2003 and December 2010, the researchers quantified chemotherapy and treatment use in the 3 months prior to death.

Patients were aged a mean of 67 years at death, and 32% had received treatment 3 months prior to death, 24% had received treatment 2 months prior to death, and 15% had received treatment 1 month before death.

Docetaxel was the most common treatment administered, at 19.4%, followed by paclitaxel, carboplatin, and doxorubin, at 15.1%, 10.8%, and 10.1%, respectively.

A total of 25% of the cohort studied experienced adverse events, with neutropenia affecting 18.3% of patients, nausea and/or vomiting 18.3%, and febrile neutropenia 13.6%.

"Attention to health-related quality of life for patients with CRPC becomes increasingly important as new treatments appear to have a small impact on survival, and side effects of those treatments may drastically impact a patient's quality of life" remark Zaghloul et al.

The team suggests that hospice care, which is associated with improved quality of life and a reduced likelihood of aggressive care, should be given greater priority in this population, as recommended by the American Society of Clinical Oncology.

"As the best available model for end-of-life care, hospice should be recognized as a valid, therapeutic alternative to continuing futile, disease-oriented therapies," the researchers conclude.

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