Secondary outcomes: survival, late hospice referrals (≤1 week before death), and dying in preferred place of death. Patients receiving palliative chemotherapy were more likely to die in an intensive care unit (11% v 2%; adjusted risk difference 6.1%, 1.1% to 11.1%) and less likely to die at home (47% v 66%; −10.8%, −1.0% to −20.6%), compared with those who were not. Patients receiving palliative chemotherapy were also less likely to die in their preferred place, compared with those who were not (65% v 80%; adjusted risk difference −9.4%, −0.8% to −18.1%). Evidence of this comes from a troubling new Dana-Farber Cancer Institute study, which found that more than half of end-stage cancer patients receive chemotherapy during the last few months of their life, and those who received such treatment were more likely to die in a hospital intensive care unit, hooked to a ventilator, rather than at home as they would have preferred. The three most common reasons for non-participation were “not interested” (n=120), “other” (n=69), and “caregiver refuses” (n=37). “There’s a subtle dance that happens between oncologist and patient,” said study leader Dr. Alexi Wright, “where doctors don’t want to broach the subject of dying because it makes those patients think we’re giving up on them.” 
 
 She and her colleagues found that chemotherapy didn’t prolong survival but did increase the likelihood of a more medicalized death: 65 percent of those on cancer drugs died in their preferred place compared with 80 percent of those who stopped treatments. As shown in table 1⇓, patients who were receiving palliative chemotherapy were more likely to be younger, married, insured, and better educated and to have better performance status, overall quality of life, physical functioning, and psychological wellbeing compared with patients who were not receiving chemotherapy (all P≤0.04). Values are numbers (percentages) unless stated otherwise View this table: Patients receiving palliative chemotherapy were less likely to acknowledge that their illness was terminal (35% v 49%, P=0.04) and to report having discussed their end of life wishes with a physician (37% v 48%, P=0.03), compared with those who were not. What is already known on this topic Many patients with metastatic cancer receive chemotherapy in the final months of life, but most are not provided with information on the likely effect on their survival, future care and quality of life, and location of death 
 
 Retrospective, population based studies suggest that cancer patients who receive chemotherapy within two weeks of death are less likely to receive hospice services, compared with those who do not 
 
 Few studies have examined prospectively whether the use of chemotherapy months before death is associated with terminally ill cancer patients’ end of life medical care and place of death What this study adds The use of chemotherapy in terminally ill adult cancer patients in the final months of life is associated with increased risk of undergoing intensive medical care near death and dying in an intensive care unit 
 
 Cancer patients, caregivers, and oncologists should have a heightened awareness about the potential risks of continuing palliative chemotherapy near death 
 
 Advance care planning is needed to ensure that patients’ end of life experiences are congruent with their values 
 
 Notes Cite this as: BMJ 2014;348:g1219 
 
 Footnotes Contributors: AAW and HGP were responsible for the study concept and design.
– Sad news for cancer patients: A new study finds that those who receive chemotherapy during the end stages of the disease are at a higher risk of enduring a less peaceful death. Of 386 terminally ill patients in a new study, 65% of those who received chemotherapy during the final few months of their life died in their preferred place (for example, at home as opposed to in a hospital). But 80% of those who had chosen to stop treatment died in their preferred location, CBS News reports. Those who continued chemotherapy were more likely to die in an intensive care unit, to undergo CPR, and to be placed on a ventilator. Those who continued treatment were also less likely to have discussed their end-of-life wishes with their doctors. "There’s a subtle dance that happens between oncologist and patient," the lead author explains to the Boston Globe. "Doctors don’t want to broach the subject of dying, especially in younger patients, because it makes those patients think we’re giving up on them." Of the subjects, who died within an average of four months after the study, 56% continued chemotherapy—and they tended to be younger, wealthier, more educated, and more optimistic about their chances of survival. The lead author thinks chemotherapy may give end-stage patients a false sense of hope.