I was concerned when I read "Marketing Strategy: Hospice Under Pressure to Admit" (Insights on Death and Dying, May 2006). You tell readers that palliative chemotherapy has no place in hospice care because it prolongs the dying process.

I hope that readers of Nursing2006 don't take the lesson that oncologists who use chemotherapy in hospice are interested in something other than the terminally ill patient's benefit. Chemotherapy can often palliate many symptoms of metastatic cancer. For example, low doses of milder agents such as etoposide can help patients suffering from dyspnea caused by pulmonary intravascular lymphomatosis. The responsible medical oncologist is constantly aware of the double-edged nature of chemotherapy and strives to minimize or eliminate adverse reactions.

The goal of symptom palliation is always to better the patient's overall condition. When chemotherapy ceases to help, other means of symptom relief take precedence.

KENNETH L. ABBOTT, M.D.

Prince Frederick, Md.