I agree with @Tyler Johnson and @Ramy Sedhom's comments about the implications of PS and specific situations where medical therapies have the potential to improve PS (heme malignancies small cell) and/or extend quality of life. I have two goals in this conversation. To make sure I understand the pat...

My answer depends almost entirely on *why* the patient's ECOG is so worrisome. If the person was physiologically elderly (regardless of chronologic age) before cancer manifested itself, then chemotherapy is very likely to be more harmful than helpful and I strongly counsel against it. If there is a...

First and foremost, I ask why the patient feels so strongly about chemotherapy if the clinical scenario suggests that therapy will be harmful. I try to understand what the patient is trying to accomplish with chemotherapy and clarify whatever misconceptions might underly the patient's reasoning. In ...