Palliative chemotherapy is prescribed to patients with cancer at end of life to alleviate symptoms and perhaps improve survival. Holly Prigerson and colleagues from the Center for Research on End-of-Life Care at Weill Cornell Medical College recently published in JAMA Oncology the results of a multi-institutional, longitudinal study of patients with progressive, previously treated cancer to evaluate the association between chemotherapy use and quality of life near death (QOD) as a function of patients’ performance status. Patients with at least one chemotherapy regimen were followed until death at outpatient oncology clients. The study concluded that the use of palliative chemotherapy did not improve QOD for patients with end-stage cancer and can even harm patients with good performance status prior. The authors call into question the routine offering of chemotherapy to patients with terminal cancers and recommend updating American Society of Clinical Oncology (ASCO) guidelines to recognize the potential harm of prescribing chemotherapy to patients with a prognosis of 6 months of less.