Many patients over-optimistic about palliative chemotherapy

A majority of advanced colorectal and lung cancer patients in the USA may not understand that chemotherapy is unlikely to cure them, according to the results of a study published in The New England Journal of Medicine.

The risk for reporting inaccurate expectations of treatment were particularly pronounced among non-White and Hispanic compared with White patients, say the researchers, as well as among those who reported having favorable communication with their physician.

"Chemotherapy may offer palliation and some prolongation of life, so it represents a reasonable treatment choice for some patients," write Jane Weeks (Dana-Farber Cancer Institute, Boston, Massachusetts) and colleagues.

"However, an argument can be made that patients without a sustained understanding that chemotherapy cannot cure their cancer have not met the standard for true ongoing informed consent to their treatment," they add.

A total of 1193 participants in the Cancer Care Outcomes Research and Surveillance study who opted to receive chemotherapy were interviewed a minimum of 4 months after their cancer diagnosis to assess treatment expectations.

Overall, patients with colorectal cancer thought that chemotherapy was more likely to be effective than did patients with lung cancer, while significantly more of both groups believed that life extension was more likely than a cure, note Weeks et al.

However, 69% of lung cancer and 81% of colorectal cancer patients gave responses to the interview questions that were not consistent with understanding that chemotherapy was very unlikely to cure their cancer.

Having colorectal cancer (vs lung cancer), and being of Hispanic or Latino, Black, or Asian or Pacific Islander (vs White) ethnicity significantly increased the likelihood for this "apparent misunderstanding," remark the researchers, with odds radios (ORs) of 1.75, 2.82, 2.93, and 2.93, respectively.

By contrast, patients who received care in an integrated network (vs not) and those who reported lower scores for physician communication were less likely to provide an inaccurate response about treatment expectation, with ORs of 0.70, and 1.37 for scores of 80-99 (out of 100) versus 0-79, and 1.90 for a score of 100 versus 79 or under, respectively.

This latter finding suggests the need for targeted education to help all physicians learn to communicate honestly while also maintaining patients' trust and regard, note the authors.

"In an era of greater measurement and accountability in health care, we need to recognize that oncologists who communicate honestly with their patients, a marker of a high quality of care, may be at risk for lower patient ratings," they conclude.

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