Patient perceptions of treatment benefit in advanced cancer.

Abstract

25 Background: Informed consent assumes accurate perceptions of potential treatment benefits and risks, yet many patients receiving palliative cancer therapies misperceive the likelihood of cure. Patients’ understanding of treatment benefits/risks beyond cure is unknown. We aimed to further explore patient perceptions of benefits/risks of palliative treatment in the era of novel therapeutics. Methods: We surveyed patients with advanced solid cancers and their oncologists regarding benefits/risks of palliative therapies. We assessed perceived likelihood of tumor response, survival benefit, symptom palliation and side effects, as well as information-seeking behavior. We used log binomial regression to estimate risk ratios (RR) and 95% confidence intervals (CI) of the association between misperception (patient perception minus physician’s perception) and various demographic, disease and treatment characteristics. Results: Of 119 patients enrolled: median age was 65 years (range 59–73), 55% male and 56% had prior treatment. Treatments included chemotherapy (60%), immunotherapy (25%) and targeted therapy (16%). Median misperceptions are shown in Table. Factors associated with decreased misperception included male gender (RR=0.70, 95% CI: 0.55–0.89), graduate level education (RR=0.63, 95% CI: 0.41–0.98) and targeted therapy (RR=0.54, 95% CI: 0.30–0.98). There was no correlation between misperceptions of tumor response and curability (r=0.13, P=0.15) or self-education (r=-0.04, P=0.69). Conclusions: Compared with their oncologists, patients’ overestimate not only curability but also chances of tumor response, symptom palliation and survival benefit; though they accurately perceive likelihood of toxicity. There is no correlation between perception of curability and other goals of therapy such as response rate and symptom palliation. Improvements in communication should focus on the likelihood of different treatment goals rather than treatment risks. [Table: see text]