Guiding Patients Facing Decisions about “Futile” Chemotherapy

When deciding whether or not chemotherapy is “futile,” the concept of medical futility must be explored.1 Though it remains difficult to adequately define, the qualitative and quantitative descriptions offered by Schneiderman et al2 are widely used. Qualitatively, futile treatment “merely preserves permanent unconsciousness or cannot end dependence on intensive medical care.” More precisely, it is a medical treatment “that in the last 100 cases … has been useless.”2 A useful, albeit imprecise, definition of futile chemotherapy is that in which the burdens and risks outweigh the benefits. As an example, studies on chemotherapy for advanced non-small-cell lung cancer (NSCLC) have shown that patients with poor performance status or chemotherapy-unresponsive disease receive little benefit in terms of response rates and survival. [3] and [4]