Terminal cancer patients hold misconceptions of the role of chemotherapy

Image: PD

Key Study Points:

1. Patients diagnosed with stage IV lung and colorectal metastatic cancer had misunderstandings of the true role of chemotherapy as a palliative treatment and not as a curative treatment.
2. Patients treated in integrative healthcare system were shown to be less likely to have these misconceptions.

Primer: Patient recognition of the inability of chemotherapy to cure stage IV lung and colorectal cancer is paramount to their decision to undergo chemotherapy and an indicator of their physician’s communication skills. Chemotherapy for such terminal patients is used to prolong their lives while maintaining quality of life. Palliative care represents a burgeoning multidisciplinary field that serves the purpose of preventing and relieving suffering with a focus on quality of life, but the objective of palliative treatment can be obscured due to a variety of issues and obstacles. Due to patient, physician and societal factors, patients with advanced metastatic cancer have been noted to be lacking in the understanding of the palliative nature of their treatment. In order to better understand this, the present study aimed to identify patients’ perspectives and interpretations of the role of chemotherapy in the treatment of their advanced cancers.

Background Reading:

1. Palliative chemotherapy for advanced colorectal cancer: systematic review and meta-analysis [BMJ]
2. A study of quality of life in cancer patients receiving palliative chemotherapy [Social Science & Medicine]
3. Relationship between cancer patients’ predictions of prognosis and their treatment preferences [JAMA]
4. What do advanced cancer patients know of their disease? [Supportive Care in Cancer]

This [cross-sectional] study:  Via phone interview, the study examined the perceptions of 1,193 patients who had stage IV colorectal or lung cancer and had chosen to undergo chemotherapy. Questions ranged from rating the physicians’ level of communication to the patients’ beliefs of the effectiveness of chemotherapy in curing or palliating their cancer. It was found that 69% of patients with lung cancers and 81% of patients with colorectal cancers held inaccurate beliefs of the curative potential of chemotherapy. Multiple regression analysis showed that patients’ who rated their physicians to have higher communication scores were also more likely to hold inaccurate beliefs (p<0.001).  Patients who were treated in integrated networks were noted to have more realistic understandings of their chemotherapy treatment (p=0.02).

In sum: An alarmingly high percentage of patients, 69% of lung cancer patients and 81% of colorectal cancer patients, with stage IV metastatic cancer had incorrect perceptions about the unlikely chances of cure with chemotherapy. Interestingly, patients who gave their physicians higher communication ratings were more likely to misunderstand the role of chemotherapy suggesting that physician communication ratings by the patient does not necessarily correlate with understanding of a specific treatment or disease process. Since prior studies have not shown such a large degree of incorrect perceptions of palliative chemotherapy, further study is warranted to further investigate this topic.

While there does seem to be incorrect perceptions, it is not clear whether this is due to the physician withholding the information, the physician not effectively conveying the nature of disease, the patient misunderstanding the physician, or the patient being in denial. As most in medicine would agree, breaking bad news, as well the most effective means of communicating with the patient about end-of-life issues, are an incredibly important and sensitive topic that merits increased attention in medical education and everyday clinical practice (see accompanying editorial). This study strongly supports the notion that there is rampant miscommunication between physicians and patients in a setting where patient understanding is absolutely crucial in choosing the best individualized course of action for patients with advanced cancer.

Click here to read the study in [NEJM]

Click here to read the accompanying editorial in [NEJM]

By [RS] and [RR]

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