At least two-thirds of patients with terminal cancers do not understand that their chemotherapy regimen is unlikely to eradicate their tumors and save their lives, according to a new survey in NEJM.
A team of researchers at the Dana-Farber Cancer Institute in Boston surveyed 1,193 patients who were diagnosed with stage IV lung or colorectal cancer between 2003 and 2005 and elected to receive chemotherapy. (The researchers surveyed providers for patients who died during the study period.)
Researchers found that just 31% and 19% of late-stage lung and colorectal cancer patients, respectively, understood that they received chemotherapy to ease their condition rather than cure it. Misunderstanding the objective of their care "could compromise [patients'] ability to make informed treatment decisions that are consonant with their preferences," the researchers stated.
The survey also found that patients who rated their physician's communicative skills more highly were more likely to misunderstand the palliative intent of their chemotherapy.
Writing in an accompanying commentary, Thomas Smith and Dan Longo of the Johns Hopkins University School of Medicine attributed the confusion to some combination of:
- Patients not being informed that their cancer is incurable;
- Physicians not effectively communicating prognosis;
- Patients being too optimistic; and
- Patients choosing to deny the message.
"I think [the findings serve] as a stark reminder to physicians: just slow down, maybe take a few minutes to realize how hard this is," says study author Deborah Schrag, adding, "Recognize that this is not one conversation, but typically a series of conversations to see if they've understood [their prognosis], and how they're acting on it" (Emery, Reuters, 10/24; Smith, MedPage Today, 10/25).