Avoid cytotoxic chemotherapy in patients with advanced cancer who are unlikely to benefit from chemotherapy (ECOG performance status 3 or 4) and continue to focus on symptom relief and palliative care.
For some patients with advanced cancer, chemotherapy is no longer effective. Symptom relief and palliative care should become the primary modes of care. The Eastern Cooperative Oncology Group (ECOG) performance status is a valid predictor of poor survival, reduced response, and worsened toxicity from chemotherapy. Patients with advanced solid tumours, with an ECOG performance status of 3 or 4, generally exhibit a poor response to chemotherapy. There are well known exceptions to this. These are generally patients with untreated highly chemo-sensitive malignancies, and who have recently declined from a good performance status.
- Baldotto CS, Cronemberger EH, de Biasi P, et al. Palliative care in poor-performance status small cell lung cancer patients: is there a mandatory role for chemotherapy? Support Care Cancer. 2012;20(11):2721–7.
- Gridelli C, Ardizzoni A, Le Chevalier T, et al. Treatment of advanced non-small-cell lung cancer patients with ECOG performance status 2: results of a European Experts Panel. Ann Oncol 2004;15(3):419–26.
- Kenmotsu H, Goto K, Kubota K, et al. Clinical significance of chemotherapy for small cell lung cancer (SCLC) with ECOG performance status (PS) 3–4. Journal of Clinical Oncology 2008 26:15_suppl, 19123-19123.
- Prigerson HG, Bao Y, Shah MA3, et al. Chemotherapy Use, Performance Status, and Quality of Life at the End of Life. JAMA Oncol. 2015;1(6):778–84.
- Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 363:733–42.
- 1 Avoid cytotoxic chemotherapy in patients with advanced cancer who are unlikely to benefit from chemotherapy (ECOG performance status 3 or 4) and continue to focus on symptom relief and palliative care.
- 2 Do not perform routine cancer screening, or surveillance for a new primary cancer, in the majority of patients with metastatic disease.
Avoid tests (biomarkers and imaging) for recurrent cancer in previously treated asymptomatic patients unless there is evidence that early detection of recurrence can improve survival or quality of life; including avoiding surveillance testing (biomarkers) or imaging (PET, CT and radionuclide bone scans) for asymptomatic individuals who have been treated for breast cancer with curative intent.
- 4 Do not perform serum tumour marker tests except to evaluate or monitor a cancer known to produce these markers.
- 5 Do not routinely offer pharmacological venous thromboembolism (VTE) prophylaxis to ambulatory outpatients who are undergoing oncological treatment.