Accuracy of oncology patients’ expectations of cure.

Abstract

e24167 Background: Efficacy of chemotherapy in gastrointestinal (GI) cancers is a well-studied endpoint. Patients require a realistic understanding of likely benefits to make informed treatment decisions. Prior studies show that patients with incurable cancer do not understand the palliative role of treatment. Patient understanding of chemotherapy intent (curative v. palliative) across all stages of GI cancers and modifying factors is unknown. Methods: Ambulatory clinic patients with GI cancers newly presenting for treatment answered validated questions on illness and treatment intent1 as part of an initiative integrating palliative care at diagnosis regardless of stage. Patients were asked to estimate probability of cure from chemotherapy with Likert responses (range ‘not at all likely’ to ‘very likely’). Two experienced oncologists (GI medical and surgical) independently assessed accuracy of patient response after reviewing patient data and grade one clinical evidence. (E.g. Patient with locally advanced stage II rectal cancer who felt chemotherapy was "somewhat likely" to be curative deemed to be 'accurate') Responses were coded as accurate or inaccurate and accuracy was compared between clinical factors with Chi-square test. Results: For 113 patients, median age was 59, 62% were male, 55% had stage IV disease. Patients were diagnosed with colon (27%), anorectal (25%), pancreatic (21%), biliary (13%), or other GI cancer (14%). There was 99% clinician agreement rating accuracy. 51 (45%) patients responded accurately. Accuracy was lower in stage IV vs. stage I-III disease (35% v 57%, p=0.02), lower in unresectable vs. resectable disease (32% v 64%, p=0.001) and higher in adjuvant vs. non-adjuvant setting of chemotherapy for stage I-III patients. (80% vs. 42%, p=0.007) Accuracy did not differ significantly by gender, age, cancer, prior surgeon visit or DNR status. Conclusions: Inaccurate perceptions about likelihood of cure with chemotherapy are prevalent across all stages of GI cancers, but particularly amongst patients with advanced GI cancer. Patients receiving adjuvant chemotherapy were more likely than metastatic patients to have accurate understanding. Next steps include mixed methods analysis of qualitative data from this cohort to evaluate factors driving inaccurate understanding of treatment. 1Weeks J et al. “Patients’ expectations about effects of chemotherapy for advanced cancer.” NEJM 367 (2012): 1616-1625.