Performance status in palliative chemotherapy treatment
Palliative chemotherapy treatments have considerable prolonged quality of life and survival for many incurably ill patients with cancer. However studies show 9-43% of the patients are treated in the last month of their life. Can a questionnaire prolong life for these patients?
Can a questionnaire prolong survival in incurable cancer? In this project a questionnaire is developed, measuring feelings of tiredness and well-being before palliative chemotherapy treatment, as a complement to blood tests routinely taken when chemotherapy treatments are administered. A cohort study of medical records in three counties showed that 23% of the patients died within a month after treatment. The questionnaire has undergone psychometric tests and exhibits promising qualities in detecting whether a patient is fit enough for treatment. To further adjust the questions interviews will be held to explore the way patients and treating nurses understand the importance of performance status in the context of palliative chemotherapy treatments.
Indications for the use of palliative chemotherapy treatment and the number of available drugs are constantly increasing. Fortunately, these treatments have considerably prolonged quality of life and/or survival for many incurably ill patients with cancer. Hence palliative chemotherapy treatment should be considered as a treatment option in every case of incurable cancer. International studies shows that 9 to 43% of incurably cancer patients are treated with palliative chemotherapy in the last month of life. The hypothesis in many studies is that at least one month of post treatment is needed to increase life span.
At the moment blood samples are routinely assessed before every chemotherapy treatment. Assessment of patients’ performance status could be an important entity as a complement to the blood samples to consider whether chemotherapy treatment is to be given or not.
The aim of this study is to optimize the decision-making before administration of palliative chemotherapy.
As base-line a retrospective study of medical records, mapping a year cohort of dead patients with cancer who had received palliative chemotherapy treatment during the last year of life is done. Then development, reliability testing and validation of a questionnaire aiming to assess performance status when patients are receiving palliative chemotherapy treatment follow. Nurses’ and patient’s opinion about the meaning of performance status will be elucidated in interviews. The results may further complete the design of the questionnaire. A randomized, controlled trial, where the questionnaire is used as an assessment tool, will illustrate if the questionnaire influences the decision to prescribe palliative chemotherapy.
This study is conducted as multi centre studies in the three most northern counties of Sweden to gather a large amount of data in a reasonable time. Identifying patients in medical records and interviews are held in the whole region. Development of the questionnaire and the RCT is done in one of the counties and in a part of another.
Key words: Malignant neoplasms, cytostatic agents, psychological phenomena and processes, palliative care