Palliative chemotherapy: When is it worth it and when is it not?

One of the most difficult questions oncologists are asked is: "Is the chemotherapy worth it, doctor?" This simple question may entail issues of benefits, risks, existential and religious concern, and financial resources. There is no one right answer, but there is a good way to approach the question. Be direct, and ask the patient what he/she wants to know, what he/she knows about the situation, and what the question means to him/her. In almost all settings, honesty with caring is the best approach, and giving bad news does not make patients depressed or give up hope. For most patients, a switch to palliative care that does not include chemotherapy should happen when the performance status is 3 or greater, defined as more than 50% of time in a bed or chair (not bed alone). In our practice, if the patient has difficulty walking to the clinic, it is time to make the transition. We illustrate some ways that this transition can occur and the benefits of a timely switch to palliative care.