Chemotherapy use and quality of life in cancer patients at the end of life: an integrative review
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REVIEW
Chemotherapy use and quality of life in cancer patients at the end of life: an integrative review Elham Akhlaghi1,2, Rebecca H. Lehto1,2, Mohsen Torabikhah3, Hamid Sharif Nia4* , Ahmad Taheri3, Ehsan Zaboli5 and Ameneh Yaghoobzadeh6
Abstract Background: When curative treatments are no longer available for cancer patients, the aim of treatment is palliative. The emphasis of palliative care is on optimizing quality of life and provided support for patients nearing end of life. However, chemotherapy is often offered as a palliative therapy for patients with advanced cancer nearing death. The purpose of this review was to evaluate the state of the science relative to use of palliative chemotherapy and maintenance of quality of life in patients with advanced cancer who were at end of life. Materials and methods: Published research from January 2010 to December 2019 was reviewed using PRISMA guidelines using PubMed, Proquest, ISI web of science, Science Direct, and Scopus databases. MeSH keywords including quality of life, health related quality of life, cancer chemotherapy, drug therapy, end of life care, palliative care, palliative therapy, and palliative treatment. Findings: 13 studies were evaluated based on inclusion criteria. Most of these studies identified that reduced quality of life was associated with receipt of palliative chemotherapy in patients with advanced cancer at the end of life. Conclusion: Studies have primarily been conducted in European and American countries. Cultural background of patients may impact quality of life at end of life. More research is needed in developing countries including Mideastern and Asian countries. Keywords: Quality of life (QOL), Health related quality of life (HRQOL), Cancer chemotherapy, Drug therapy, End of life care, Palliative care, Palliative therapy, Palliative treatment Introduction Best practices for management of advanced cancer are of global health concern, particularly in developing countries [1]. When curative strategies are exhausted, the focus of cancer care shifts to maintenance of quality of life (QOL) and extension of survival [2]. Studies indicate that – 20 to 50% of patients with advanced cancers receive chemotherapy (CT) towards end of life with the *Correspondence: [email protected]; [email protected] 4 Department of Nursing, Mazandaran University of Medical Science, Sari, Iran Full list of author information is available at the end of the article
aims of extending survival and improving QOL [3–5]. Such rigorous treatment strategies may contribute to death in non-preferred environments such as the intensive care unit (ICU), incurring additional costs for care that is often futile and that may also diminish QOL in the patients’ final days. Intensive medical management at end of life may also limit the opportunity for patients to receive hospice services, supportive care that focuses on enhancing comfort and promoting quality of life when facing death [6]. The purpose of the review was to examine the state of the scienc
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