Dying cancer patients ‘should not always be given chemotherapy’

It often does more harm than good, say top doctors

DOCTORS should think twice before offering chemotherapy to dying cancer patients, according to senior medical experts.

The treatment is unlikely to work, may ‘raise false hopes’ and will probably do ‘more harm than good.’

Currently thousands of cancer patients have so-called palliative chemotherapy to relieve symptoms in their final months.

The drugs can ease pain and may also extend their lives giving them extra time to spend with loved ones.

But guidelines by the Academy of Medical Royal Colleges state that the treatment will probably only be of ‘small’ benefit.

Instead, the organisation wants doctors to have proper discussions with patients about the unpleasant side effects – and the fact the treatment probably won’t work.

Cancer Research UK appeared to question the advice and said palliative chemo-

‘Benefit is likely to be small’

therapy does relieve symptoms for some patients. The new guidelines published today urge staff to avoid a total of 40 apparently unnecessary procedures which also include plaster casts for broken arms and x-rays for back pain.

But they will prompt concern that the academy is trying to save the NHS money by urging doctors to avoid costly treatments.

The organisation is hugely influential and represents 24 royal colleges and other health bodies.

Professor Dame Sue Bailey, its chair, said staff had a ‘duty to look after resources’ – but insisted money wasn’t its motivation.

She said too many doctors were currently offering patients treatments or tests just because they were available.

There are no figures for the numbers of cancer patients given palliative chemotherapy but the academy said it was happening ‘frequently.’ The guidelines – aimed at doctors and patients – state: ‘Chemotherapy is by its very nature toxic. Therefore the combination of failing to achieve a response and causing toxicity can ‘do more harm than good…

‘Finally, the use of chemotherapy with a low chance of a meaningful response can raise false hopes.

‘If you have advanced cancer, the use of chemotherapy where the benefit is likely to be small and the harm may be great should be carefully considered.’

Dame Sue insisted the guidelines hadn’t been ‘plucked out of the air’. She added: ‘We all have a duty to look after resources in healthcare, especially when the NHS is under so much pressure, but that’s not the main motivation for this initiative.

‘What’s much more important is that both doctors and patients really question whether the particular treatment is really necessary.

‘Using chemotherapy to relieve symptoms – when we know it actually causes patients more distress – has to be considered.’

Vanda Taylor, Cancer Research UK’s senior cancer information nurse, said: ‘In some cases, chemotherapy does help relieve symptoms of advanced cancer. It can have side effects, and this is why patients need to talk this over with their doctor before making a final decision. Any treatment suggested has to be carefully weighed up in terms of the likely benefit.’

The guidelines also tell staff not to give children a plaster cast if they have a small fracture as they get better with a ‘removable splint’.

Cuts and grazes should be washed with drinking water from the tap – rather than a sterile solution. Blood pressure drugs should only be offered to patients who are at high risk of heart attacks and strokes.