What is Palliative Chemotherapy?

What is the Purpose of Palliative Chemotherapy?

nurse and patient discussing palliative chemotherapy
What is palliative chemotherapy and what questions should you ask your oncologist?. Credit: istockphoto.com

The term palliative chemotherapy means something different than terms such as "adjuvant chemotherapy" or "neoadjuvant chemotherapy" but many people are confused by the differences. Unfortunately, due to the different ways in which chemotherapy is used, people may have either false expectations of what chemotherapy can accomplish, or, on the other hand, may dismiss very real benefits that these treatments may have. Palliative chemotherapy, unlike other forms of chemotherapy, refers to the use of chemotherapy to extend live or reduce symptoms, but is unlikely to "cure" a cancer.

Let's take a close look at exactly what palliative chemotherapy means, when it might be used, the possible side effects you might expect, and the questions you may wish to ask your oncologist if this treatment is offered.

Palliative Chemotherapy: Definition

Palliative chemotherapy is chemotherapy treatment which is given to relieve the symptoms of cancer, but not meant to cure cancer or to extend life to a significant degree.

It's very important to understand the purpose of chemotherapy given in this way. A recent study suggested that most patients with stage 4 cancer were not given clear information and did not properly understand the purpose behind chemotherapy given by this approach. Many people somehow hoped they would be "different" and that perhaps the chemotherapy would give them a chance to survive longer.

While those thoughts bring hope, if there is ​the potential of a treatment to increase survival or a rare chance that it may cure a cancer, your oncologist will share that with you. It can be heart wrenching to realize that a treatment does not have even a rare chance of curing a cancer for some people, but knowing this up front can help you make the most educated and thought out choice.

As you consider this decision, it is also important to talk to your oncologist about recent findings which showed that palliative chemotherapy may worsen quality of life. As many treatments in medicine, every cancer is different and every individual is different, so statistics are not necessarily very meaningful when considering your own treatment.

Goals of Treatment

It can be confusing to talk about treatment at this stage of a cancer, so let's review the overall goals of medical treatments first. These goals include:

  • Preventive treatment: This treatment is done in attempt to prevent a disease or complications of a disease
  • Curative treatment :This type of treatment is done with a hope of curing a disease
  • Treatment done to extend life: Treatment done to extend life is done with a purpose of achieving long term (however long possible) of a cancer
  • Disease management: Disease management treatment may be done to stabilize or reverse some of the symptoms related to a disease
  • Palliative treatment: Palliative treatment, as noted above, is done with the purpose of controlling and hopefully relieving the symptoms of cancer in order to improve quality of life

The Goals of Palliative Chemotherapy

In talking about palliative chemotherapy, it is first important to understand the overall goal of your treatment as noted above and make sure you are not thinking, or hoping, for results that aren't consistent with this type of treatment. An example may help explain this. If your doctor has suggested palliative chemotherapy but you are still hoping for curative treatment, you should have a conversation. Are there any possible options still available that would fit with that approach? Perhaps she knows of a phase I clinical trial, a trial in which a drug is first being studied on humans, which could possibly offer a chance for a cure? With lung cancer, there are currently many clinical trials looking at targeted therapies and immunotherapy treatments which may be a better option of you are interested in a curative attempt at treatment. Some of these treatments may also be combined with chemotherapy.

If you are comfortable with palliative chemotherapy as an option, consider what the goals of this treatment would be for you. Palliative chemotherapy is designed to:

  • Relieve Symptoms: By reducing the size or spread of, but not eliminating a tumor, palliative treatments may be used to improve symptoms caused by a cancer. Examples of symptoms that might be treated this way include pain caused by a tumor pushing on various structures in the body, or shortness of breath caused by a tumor obstructing an airway or taking up too much space in a lung.
  • Slow Progression of Cancer: Sometimes palliative chemotherapy can slow the growth of cancer and extend life, even though it does not cure the cancer. Talk to your oncologist about whether this is a possibility, so if it is very unlikely, you will not be disappointed.
  • Improve Quality of Life: By reducing symptoms such as pain and shortness of breath, palliative treatments may improve well-being and quality of life.

It's important to note another reason for chemotherapy that was not a consideration even a few short years ago. Studies are now looking at the effect of both chemotherapy and radiation therapy when combined with immunotherapy. Immunotherapy drugs are treatments that essentially help your immune system recognize and attack cancer cells. There is some evidence that the breakdown of cancer cells caused by chemotherapy and radiation can act as a "stimulant" for the immune system, providing broken down cells that help the body recognize cancer. Used in this fashion, chemotherapy may improve the effectiveness of some immunotherapy drugs.

Questions to Ask:

In making this hard decision, it may help to ask some specific questions. You may wish to go over this list (and questions you add to it) with your oncologist, as well as with your loved ones. As you answer these questions it's important to consider what is best for you alone. Family members often have different opinions and may choose a different approach if it were them and not you making the choices. Listen to what your family has to say and consider their thoughts, but make a decision which honors your own feelings and beliefs about your own needs and wishes. Consider these questions.

  • Should I expect that this chemotherapy will lengthen my survival?
  • Is there a chance that the chemotherapy could shorten my survival?
  • What are the side effects I may experience from the chemotherapy vs the symptoms we are trying to relieve?
  • How long do people usually respond to this type of chemotherapy?
  • What will this chemotherapy mean for me? What is the cost? Will I have to travel for treatment?
  • How soon will I know if it is making a difference?
  • If I choose to take palliative chemotherapy, will that disqualify me from being in a hospice program?
  • If I choose palliative chemotherapy, could that potentially disqualify me if a clinical trial becomes available for my cancer?

Stopping Cancer Treatment

Choosing to stop cancer treatment is a very difficult decision, and often leads to conflict and hurt feelings as well, if loved one and family do not agree with each other or with you on the next planned steps. Check out these 9 things to consider when choosing to stop cancer treatment.

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