Patient’s Misperceptions about the Effectiveness of Chemotherapy in Advanced Cancers

Abstract

Although chances of cure are low, patients with advanced cancers may be offered therapies which may prolong life or palliate symptoms. Patients with advanced cancers who accept chemotherapy do necessarily understand or accept the high probability that their cancer may be cured. The article reviewed here demonstrates these misperceptions by surveying patients with advanced lung and colorectal cancers. Their findings indicate that the large majority of these patients believed that undergoing chemotherapy was to cure their disease. However, of patients who portray an understanding of the incurable nature of chemotherapy, satisfaction with physician communication may be compromised. these results apply to patients with other advanced cancers in different specialties may offer directions for future research. Background Although chemotherapy is the mainstay of treatment for patients with metastatic lung or colorectal cancers, it is curative, with minimal survival benefit, being measured in months or even weeks. Likewise, patients with advanced gynecologic cancers, such as ovarian cancer experience similar marginal survival benefit when undergoing chemotherapy, especially in the setting of recurrent disease. Though chemotherapy may provide palliative benefit, many therapies are also associated with substantial toxicities which may affect Quality of Life (QOL) and end-of-life care. Up to one-fifth of all cancer patients are treated with chemotherapy in the last month of life without clear benefits (e.g. no prolongation of life) and sometimes even with visible negative consequences (increased toxicity, costs and decreased QOL) (1). It is therefore imperative that patients have realistic understanding of the nature of the their disease and the poor likelihood of cure in order to truly provide informed consent to treatment in the setting of advanced disease. Recent evidence has suggested that many patients with metastatic cancers hold the belief that palliative chemotherapy may be curative. The authors in this study sought to further characterize the expectations of patients with metastatic lung or colorectal cancer about the effectiveness of chemotherapy. Methods and Results from Paper Using data from the Cancer Care Outcomes Research and Surveillance (CanCORS) study, patient's beliefs regarding the nature of palliative chemotherapy was investigated. The CanCORS study is national, prospective, observational cohort study, which enrolled patients with newly diagnosed lung or colorectal cancers. Of the cohort, which included approximately 10,000 patients, the authors presented data on 1193 patients. These were patients with newly diagnosed Stage IV lung or colorectal cancer who opted to receive chemotherapy. They were surveyed by professional interviewers regarding their beliefs about the effectiveness of chemotherapy. The surveys were conducted 4 to 7 months after the diagnosis. Surrogates were interviewed in the case of patient being too ill to be interviewed or who had died. An item adapted from the Los Angeles Women's Health Study was used to assess responses regarding the effectiveness of chemotherapy. Patients were asked how they thought chemotherapy would you live longer, cure your cancer, or help you with problems you were having because of cancer. Responses were rated as very likely, somewhat likely, a little likely, not at all likely, or don't know. Patients were also asked about physician communication using the sum of five items derived from the Consumer Assessment of Healthcare Providers and Systems (CAHPS). In assessing physician communication, patients were asked How often did your doctors… listen carefully to you, explain things in way you could understand, give you as much information as you wanted about your cancer treatments (including potential benefits and side effects), encourage you to ask all the cancer-related questions you had, and treat you with courtesy and respect. This item was scored 0 to 100, with higher scores indicating better physician communication, and categorized into tertiles. Other items assessed by the survey included measure of physical functioning based on the European Quality of Life-5 Dimensions, characterization of the patient's role in decision making about chemotherapy, as well as demographic data including age, sex, educational level, race or ethnic group, marital status, and household income. Patients were classified as receiving their care in an integrated network if they were enrolled in the study through the Veterans Affairs, health maintenance organization sites, or through Kaiser Permanente of Northern or Southern California. The primary outcome evaluated whether patients had an accurate assessment that chemotherapy was to be curative. Responses were considered inaccurate if the patient considered the curative intent of chemotherapy to be very likely, somewhat likely, a little likely, or don't know. Sensitivity analyses were also performed to analyze the effect of including don't know or refusal to answer as accurate, or the effect of only classifying responses of very likely to be inaccurate. In all, the large majority of patients gave inaccurate responses with 69% of lung cancer patients and 81% of colorectal cancer patients