It is an agonizing decision for terminally ill cancer patients and their families. Should they undergo more chemotherapy?

The answer is usually no for very sick patients. But palliative chemo is often considered a reasonable option for those who are stronger, because of the hope that it may ease symptoms or buy time.

Now, a study suggests that end-of-life chemotherapy is more likely to make things worse. The work in JAMA Oncology followed more than 300 patients with a prognosis of less than six months to live. About half opted for end-stage chemotherapy.

Researchers found that treatment worsened quality of life for those patients who could still work and perform day-to-day tasks when the study started. And it didn’t improve things for those who were sicker at the beginning.

The findings are the opposite of what was expected because the patients who were assumed to benefit did not. The lead researcher says the bottom line is that incurable cancer patients with a limited life expectancy who use chemotherapy are likely to impair the quality of their remaining days.