A diagnosis of stage IV colon or lung cancer is made, and the patient is approached with treatment options.
A recent study by Weeks et al. in the New England Journal of Medicine is giving new insight into how some patients understand the goals of treatment options. The study found that 69 percent of lung cancer patients and 81 percent of colon cancer patients with stage IV disease mistakenly believed that chemotherapy could cure their disease.
Patients who chose chemotherapy were interviewed 4-7 months after diagnosis on the likelihood of this treatment curing their disease, extending their life, or relieving their symptoms. The percentage who believed they would be cured was higher among black, Hispanic, and Asian/Pacific Islander patients than among Caucasian patients. Interestingly, patients who said chemotherapy was curative gave a more favorable rating of their oncologists.
What conclusions could we draw from this study? Communication with the oncologist is key. It is very hard to give bad news. Though the prognosis may be given at some point, the patient may misinterpret the outcome if the focus moves quickly to treatment options. And what is the possible impact on the patient who mistakenly believes he/she will be cured? Maintaining hope and a positive attitude is important, but are patients making a really informed decision if they are basing the chemotherapy decision on false beliefs? Would these people make the same choices and face the potential risks if they acknowledged the low likelihood of cure?
Though communication with the oncologist was the focus of this study, the whole treatment team has a role in assessing and communicating about the treatment goals. Here are some suggestions for improving open communication with the advanced cancer patient.
- Make regular reviews of prognosis, disease progression, and options on recurrent visits, so there is a series of discussions rather than one very painful conversation near the end.
- At every review session, seek the patient's response to this news. Encourage the patient to share what he/she has heard.
- Discuss patient goals regularly.
- Encourage the patient to bring a loved one to these meetings, so two people are hearing the same information.
- The oncology team should regularly assess the patient's understanding of the disease and treatment and develop a plan to address concerns.
- Introduce palliative care and hospice early on in the treatment as options, rather than as a handoff at the very end.
What strategies have you found effective when communicating with advanced cancer patients about their diagnosis and prognosis? If a patient has inaccurate beliefs about the goal of treatment, what do you do?